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Making female condoms available

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Making female condoms available Powered By Docstoc
					Making female condoms
available and accessible




A guide on implementing female condom programs
Index
Foreword                                                                                         7

Introduction                                                                                    8

Chapter 1. Process                                                                              12
  1.   Introduction: The complexities of female condom programming                              12
  2.   Planning phase: Planning your female condom program                                      13
           2.1    Preparation                                                                   13
           2.2    Research                                                                      14
           2.3    Formulating objectives and indicators                                         15
           2.4    Program design                                                                16
  3.   Implementation phase: Implementing and monitoring your female condom program             18
  4.   Evaluation phase: Evaluating your female condom program                                  20


Chapter 2. How to govern your female condom program                                             23
  1.   Introduction: How to build for responsibility and commitment                             23
  2.   Operational team: Fruitful cooperation is the key to success                             24
           2.1    Lead organization                                                             24
           2.2    Community-Based Organizations (CBOs)                                          26
           2.3    Peer educators                                                                25
  3.   Installing a supervisory body                                                            26


Chapter 3. Community approaches                                                                 28
  1.   Introduction: Female condom promotion requires subtlety and sensitivity                  28
  2.   Working from within is the way to go                                                     28
           2.1    Civil society implementing partners                                           29
           2.2    Private sector partners                                                       31
           2.3    Stakeholders in the public sector                                             32
  3.   Capacity building                                                                        33
  4.   Reaching out to the community: added value of implementing partners and peer educators   33


Chapter 4. How to communicate with potential users                                              36
  1.   Introduction: a carefully developed communication strategy is the key                    36
  2.   How to determine your target audience(s)                                                 36
  3.   Branding and rebranding the female condom                                                37
           3.1    Rebranding: Is it worthwhile?                                                 37
           3.2    Branding campaigns                                                            38
  4.   Messages                                                                                 38
           4.1    Examples of messages                                                          39
  5.   How to communicate about the female condom                                               40
           5.1    Inter-personal communication                                                  40
           5.2    Sensitization sessions                                                        40
           5.3    Edu-tainment: Road shows and drama performances                               40
           5.4    Drama performances                                                            41
           5.5    Visuals: Leaflets, posters and banners                                        41




                                                                                                     3
      6.   Promotional materials and tools                                              41                10.1 Distribution free of charge                                                63
               6.1      Developing material                                             41                10.2 Selling the female condom                                                  63
      7.   Involving role models to convey your message                                 42                10.3 Sampling                                                                   63
      8.   Media for female condom promotion                                            43      11.   Complementary approach                                                              64
               8.1      Media planning                                                  44      12. Corporate Social Responsibility                                                       65
               8.2      Media channels                                                  44      13. Female condom demonstration models                                                    65
               8.3      Monitoring                                                      44
               8.4      Capacity building of media and partnerships                     44   Chapter 7. The involvement of men: It takes two to tango                                     66
      9.   Visibility                                                                   45      1.    Introduction: What’s in a name?                                                     66
      10. Advantages and disadvantages of the use of different communication channels   45      2.    How to use the media for promotional purposes                                       66
                                                                                                3.    How to adapt your messages to attract men’s attention                               67
    Chapter 5. Advocacy towards decision makers                                         48                3.1   Using role models to spread the word                                      68
      1.   Introduction: Exerting influence to bring about positive change              48      4.    Partnerships will contribute to your cause                                          68
      2.   What is advocacy?                                                            48
               2.1      Why is advocacy important?                                      48   Chapter 8. Creating demand, increasing access                                                70
      3.   Developing an advocacy strategy                                              49      1.    Introduction: Team up and wise up!                                                  70
               3.1. Defining the issue                                                  50      2.    Partnerships with public and private sector players                                 70
               3.2      Set overall goal and objectives                                 50                2.1   Non-commercial, not-for-profit                                            70
               3.3      Identify Target Audience: advocacy towards the government       51                2.2   Commercial, for profit                                                    70
               3.4      Build support                                                   52      3.    Social marketing: Our good practice!                                                71
               3.5      Develop your message                                            52                3.1   Four P’s                                                                  71
               3.6      Channels of communication                                       53      4.    Complementarities and collaboration                                                 73
               3.7      Raise funds                                                     53
               3.8      Develop your implementation plan                                54   Annex 1: Focus Group Discussion Guide for current users and non-users of the female condom   74
               3.9      Ongoing steps: Data Collection and Monitoring                   54
                                                                                             Annex 2: Example of a Female Condom Program Goal and Objectives                              77
               3.10 Evaluation                                                          54
                                                                                             Annex 3: Communication Strategy Outline                                                      78
      4.   Creating conducive environment outside of the policy field                   54
               4.1      Community leaders and gate keepers                              54   Annex 4: Outline of an Advocacy Plan                                                         79
               4.2      Donors and other institutions                                   55   Abbreviations                                                                                80
                                                                                             Bibliography and further reading                                                             81
    Chapter 6. Procurement and Supply Chain Management                                  58   Frequently Asked Questions                                                                   84
      1.   Introduction: Availability is key                                            58
                                                                                             Glossary                                                                                     87
      2.   What is procurement?                                                         59
      3.   Shipment and customs clearance                                               59   Acknowledgements                                                                             89
      4.   Testing                                                                      59   Colophon                                                                                     90
      5.   Wrapping and packaging                                                       60
      6.   Storage                                                                      60
      7.   Transportation                                                               61
      8.   Distribution through different channels                                      61
               8.1      Community-level: Peer educators and CBOs                        61
               8.2      Pharmacies and drug stores                                      62
               8.3      Non-traditional outlets                                         62
               8.4      Public health system                                            62
      9.   Keeping Stock                                                                62
      10. Distribution                                                                  63




4                                                                                                                                                                                              5
    Nigeria   Cameroon   Zimbabwe   Mozambique   Foreword
                                                 Female condoms should be available, accessible and affordable,    For these and other reasons, I am proud that the Dutch Ministry
                                                 because they are the only female-initiated method of protection   of Foreign Affairs is a founding member of the Universal
                                                 against unwanted pregnancy and sexually transmitted               Access to Female Condoms Joint Programme (UAFC). This
                                                 infections. The facts are, however, that the female condom is     partnership aims to incorporate the female condom into regular
                                                 expensive, requires some instruction for use and is far from      reproductive health programming, so that it will ultimately be
                                                 being readily available at every corner shop.                     just as common and accepted as the male condom or hormonal
                                                                                                                   contraception.
                                                 The use and availability of the female condom is part of a
                                                 broader issue: the unmet need for family planning. According      This Implementation Guide on Female Condom Programming
                                                 to UNFPA, at least 200 million women would like to use safe       is an important and concrete result of the work of UAFC
                                                 and effective family planning methods, but have no access to      and its partners. The Guide offers valuable information
                                                 information or services, or lack the support of their husbands    about implementing female condom programmes, based on
                                                 and communities. This concern is even more pressing in the        experiences in Nigeria, Cameroon, Zimbabwe and Mozambique.
                                                 light of women’s increasing vulnerability to HIV infection.       It is a practical tool for current and future programmers
                                                                                                                   worldwide.
                                                 The issue of female condoms is also connected to the
                                                 Millennium Development Goals (MDGs), in particular MDG5,          When the Dutch Ministry of Foreign Affairs joined the UAFC
                                                 which is aimed at reducing maternal mortality and increasing      partnership, we were convinced that the female condom market
                                                 the accessibility of reproductive health services. Progress       needed an innovative impulse. We felt this public-private
                                                 towards achieving MDG5 is slow. That is why I have made sexual    partnership had the potential to make a difference in the areas
                                                 and reproductive health and rights (SRHR) − including HIV/AIDS    of global health and human rights.
                                                 – one of my four policy priorities.
                                                                                                                   This Implementation Guide proves that supporting UAFC
                                                 Increased female condom use will also help to achieve MDG3        was a smart move. I congratulate our UAFC partners and the
                                                 (promoting gender equality and empowering women), MDG6            implementing agencies on this publication, and sincerely hope
                                                 (combating HIV/AIDS and other diseases) and the objectives set    that it will help lead to available, accessible and affordable
                                                 out in the Programme of Action of the International Conference    female condoms for all.
                                                 on Population and Development (ICPD).
                                                                                                                   Ben Knapen
                                                                                                                   Minister for European Affairs and International Cooperation




6                                                                                                                                                                                    7
    Introduction
    The female condom: We invite you to join our global effort!                                                    • Unlike with the male condom, the sex does not need to be                                        Why is specific female condom programming necessary?                                                   It is evident that female condoms contribute to the variety
    Imagine a contraceptive that offers women protection against                                                     interrupted: the female condom does not need an erection                                        There is a desire to use the female condom, by both women and                                          of contraceptive choices and address urgent sexual and
    unintended pregnancy, HIV/Aids and other sexually transmitted                                                    and can therefore be inserted before sex. Furthermore, it                                       men. However, female condom programming is more complex                                                reproductive health problems, such as unintended pregnancy
    infections (STIs), and which also enhances sexual pleasure for                                                   does not require immediate withdrawal after ejaculation.                                        than that of, for example, male condoms. Since the female                                              and sexually transmitted infections, including HIV/Aids. In
    both themselves and their partner. This is the female condom!                                                                                                                                                    condom is a woman-controlled contraceptive, its promotion                                              many countries, female condoms are not widely available.
    Women and girls face the consequences of unprotected sex                                                       • Qualitative studies among women using the female condom                                         may confront deeply rooted ideas about sexuality, gender                                               This accounts for limited access, often exclusively through
    and bare the huge burden of unintended pregnancy and the                                                         show an increased sense of power in negotiating safer sex                                       equality and women empowerment. It is also more complex                                                the public health sector. Introducing female condoms more
    risk of infection, including HIV/Aids1. The female condom is                                                     and a greater sense of control and safety during sex 2.                                         than programming other women-initiated contraceptives like                                             widely needs truly large-scale programming in the sense that
    the only contraceptive that offers dual protection against both                                                • The female condom has no side effects and can be used                                           the pill, because female condom use involves education on                                              all different aspects of successfully introducing it into the
    pregnancy and STIs, including HIV/Aids, and is available now.                                                    without seeking assistance of a healthcare provider. People                                     sexual intercourse and the woman’s private parts.                                                      market are included, e.g. procurement of the female condom,
    These are strong arguments in favor of wider availability and                                                    who are allergic to latex can still use the FC2, currently the                                  That is why it’s most important to —first and foremost— focus                                          supply chain management, promotion on community level,
    programming of the female condom, but there are many more                                                        most commonly used female condom, because it is made of                                         on normalization of the female condom. This will lead to                                               media engagement, and advocacy. However, implementers
    advantages:                                                                                                      nitrile, a material that is just as reliable.                                                   demand creation. Consequently, it is of great importance to give                                       should embed the program within existing policy frameworks
                                                                                                                   • Female condom use increases sexual pleasure: studies                                            special attention to the female condom by organizing specific                                          and programs, while working closely with government and civil
                                                                                                                     report a high satisfaction rate by both women and men                                           programming around it.                                                                                 society5.
                                                                                                                     who have used the female condom. Men like it because the
                                                                                                                     female condom is not tight or restricting and they experience                                   Specific large-scale female condom programming is important
                                                                                                                     more stimulation. Women like it because the female condom                                       for several reasons:
                                                                                                                     is highly lubricated and the material heats up to body                                                                                                                                                     Bassomo William Isidore, motor taxi driver
                                                                                                                     temperature.                                                                                    1. In most countries, female condoms are a largely unknown                                                 Douala, Cameroon, 5 November 2010
                                                                                                                   • Female condoms expand the contraceptive method choice.                                             product: they are either not available at all or only in very                                           “I prefer the female condom to the male condom. Sex is
                                                                                                                     Studies have shown that providing women and men different                                          small quantities and are hardly marketed, if at all. New                                                more natural with the female condom than with the male
                                                                                                                     options in using contraceptive methods increases the                                               products always need special attention when they enter                                                  condom. It’s like you are getting into a women directly.
                                                                                                                     likelihood of contraceptive use3.                                                                  the market: people need to know about it and need to know                                               It was a bit difficult at the beginning but I am used to it
                                                                                                                                                                                                                        where they can get it. Without sufficient investment in                                                 now. My wife first introduced the device to me but now I
                                                                                                                                                                                                                        procurement and marketing of the product, components that                                               am the one buying them. I spotted the posters advertising
                                                                                                                   Large-scale female condom programming is lagging behind                                              are both part of the large-scale programming that is being                                              the female condom in the shop here so I stopped my bike
                                                                                                                   Despite these convincing advantages, globally, female condoms                                        advocated for in this guide, this will remain as it is and will                                         and asked if I could buy them here. Ever since then, I
                                                                                                                   are still not widely programmed on a large scale. This is not                                        further restrict the growth of demand. In other words: large-                                           have come back here to buy female condoms. The male
                                                                                                                   to say that female condoms have never been programmed:                                               scale programming is needed for demand creation.                                                        condom does not interest me anymore because it restricts
                                                                                                                   female condoms have been made available to specific target                                        2. Despite their importance, female condoms are not an easy                                                movement during sex.”
                                                                                                                   groups in the past, most notably to female sex workers. There                                        product to sell. Female condoms are used for sex. More
                                                                                                                   is a high satisfaction rate among these specific groups and we                                       particularly they are designed for women having sex. And
                                                                                                                   need to continue to make the female condom available to them.                                        they give women more control over the protection of their                                           An implementation guide on female condom programming
                                                                                                                   However, we believe that the female condom is a contraceptive                                        bodies. As all of this is a taboo in many societies, the product                                    This Implementation Guide on Female Condom Programming
                                                                                                                   method that benefits all people who are sexually active, in                                          needs to be marketed carefully.                                                                     aims to facilitate the expansion of large-scale female condom
                                                                                                                   terms of sexual pleasure and family planning as well as HIV/Aids                                  3. Closely related to the first two: many myths and                                                    programming worldwide, so that the female condom will be
                                                                                                                   prevention. Women who have a high risk of infection with HIV4                                        misconceptions about the female condom exist, often due                                             available, accessible and affordable for all women and men.
                                                                                                                   within their marriage can highly benefit from using a female                                         to ignorance about the product. These need to be countered                                          This guide is written for (potential) implementers of large-scale
                                                                                                                   condom and from being able to negotiate its use with their                                           by continuous positive and accurate messages about the                                              female condom programs of national and international NGOs,
                                                                                                                   partner. For couples that want to plan their families, the female                                    benefits of female condom use at all levels of society.                                             CBOs, donors, health practitioners, and other professionals in
                                                                                                                   condom is a reliable contraceptive method. People living with                                     4. When encouraging the use of the female condom and                                                   the field of health, sexual and reproductive health, HIV/Aids
    Female Condom FC2                                                                                              HIV/Aids can trust the female condom in avoiding transmission,                                       increasing its acceptance, it is very important that women                                          prevention, and gender.
                                                                                                                   and can therefore enjoy having sex without worries.                                                  and men receive accurate information and education about
    • The female condom is a women-initiated contraceptive,                                                                                                                                                             the female condom in a safe environment. The use of the                                             This Implementation Guide represents the experiences, lessons
      which means that women are in control when they use them.                                                    The female condom is more expensive than the male condom,                                            female condom is not self-explanatory and inter-personal                                            learned, challenges and successes of the female condom
      The use of male condoms often has to be negotiated over                                                      although larger-scale production could lower the price                                               communication explaining its proper use is therefore vital to                                       programs of our colleagues in Cameroon, Nigeria, Mozambique,
      and over again, often in the form of an interruption during                                                  over time. Compared to life-long HIV/Aids treatment or the                                           its success. Also, the first time one uses the female condom,                                       and Zimbabwe. Zimbabwe currently has a successful female
      sex. Female condoms have to be negotiated only once. Once                                                    consequences that an unintended pregnancy may have, the                                              insertion may not be smooth. Like with the male condom,                                             condom program, which was initiated approximately fifteen
      the male partner agrees to use it, the woman can insert it                                                   female condom is in fact very cost-effective.                                                        using it takes a bit of practice. Women need to be able to ask                                      years ago. In Nigeria and Cameroon, large-scale female condom
      each time before sex. No action is required from the man.                                                                                                                                                         questions to peer educators about the female condom and                                             programming was initiated in 2009 as part of the Universal
                                                                                                                                                                                                                        get support to use it.                                                                              Access to Female Condoms (UAFC) Joint Programme, and in
      1 In Sub-Sahara Africa, 60% of people infected with HIV are women. UNAIDS (2010), Report on the Global Aids Epidemic, page 30.
                                                                                                                                                                                                                                                                                                                            Mozambique it was kicked off only recently. These programs
      2 Gollub EL. The female condom: tool for women’s empowerment. American Journal of Public Health 2000;90(9):1377–81.
      3 Fontanet AL, Saba J, Chandelying V, et al. Protection against sexually transmitted diseases by granting sex workers in Thailand. the choice of using the male or female condom: results from a randomized

       controlled trial. AIDS 1998;12(14):1851–59.
      4 In Sub Sahara Africa HIV transmission often occurs within marriage: In Zambia 60% of the people newly infected are infected within marriage or cohabitation. In Swaziland this is 50%–65%, and in Kenya an     5 The Comprehensive Condom Programming (CCP) Rapid Need Assessment and Strategic Planning Tool of UNFPA can guide implementers in integrating condom programming in existing policy frameworks.

       estimated 44%. UNAIDS (2010), Report on the Global Aids Epidemic, page 30.                                                                                                                                       http://unfpa.org/webdav/site/global/shared/documents/publications/2011/CCP.pdf




8                                                                                                                                                                                                                                                                                                                                                                                                                        9
     are being implemented in very distinct contexts and have been                                                  In Nigeria, Victoria, Ifeoma, Mimi, Jennifer, May and their                                   How to use this guide?                                              should aim for modest targets: in the first year you will need to
     adapted accordingly. Each program has generated new ideas                                                      colleagues at Society for Family Health (SFH), Girls’ Power                                   This guide will offer you the opportunity to get a comprehensive    invest in the program’s structure. You may increase your targets
     and insights regarding what it means to conduct female condom                                                  Initiative (GPI) and Lift Above Poverty Organization (LAPO)                                   overview of all different aspects of large-scale female condom      once your program has been running for a while.
     programming successfully.                                                                                      and many others work around the clock to encourage female                                     programming. The guide is however structured such that you
                                                                                                                    condom use to a wide audience. In less than three years (2008-                                can pick and choose the themes that are particularly relevant       It is most important that donors, governments and communities
     The female condom programmers who worked hard to collect                                                       2011), the number of Nigerian sales points that sell the female                               for you to learn more about, depending on the context in which      notice the effectiveness of female condom programming,
     their knowledge and experiences to be shared with you in                                                       condom has increased from 3% to 45% in Edo State alone7.                                      you are implementing your program. It is important to note that     realize that demand for the product exists once people become
     this guide, are all very passionate about the female condom.                                                   This is perfect proof that female condom programming is able                                  this guide discusses steps and lessons learned, assuming that       acquainted with the product, and come to regard the female
     They know first hand of the problems that couples face when                                                    to account for an enormous increase of access to the female                                   funding has been secured already. Hence, fundraising is not         condom as complementary to the other available contraceptive
     expressing their sexuality, planning their families, protecting                                                condom in only a short amount of time.                                                        discussed here.                                                     choices. Ultimately, it is your goal to make the female condom
     themselves against unintended pregnancy and Sexually                                                                                                                                                                                                                             accessible, available and affordable for all. Hence, repeated and
     Transmitted Infections (STIs) including HIV/Aids, and when                                                     In Zimbabwe, Patience, her supervisor Kumbirai and the care                                                                                                       sustained use is key. The strategies that are being discussed in
     attempting to have pleasurable and consensual sex. On a daily                                                  Initiative team of PSI Zimbabwe work hard to keep up the                                                                                                          this guide will help you to achieve this.
     basis, they experience people’s curiosity with regard to the                                                   good work that they have been doing for over fifteen years.                                      Mercy Odiase, HIV positive women, 39 years, trader in bags
     female condom. Many people want to try it and, once they do,                                                   Zimbabwe has had a female condom program since 1996, in                                          Benin City, Nigeria, 3 November 2009
     they often love it! At the same time, (potential) users have many                                              which it teams up with the government. Clearly, the social                                       “HIV positive women can have sex again. I myself have            Let’s make a global effort!
     questions and concerns about female condom use. Female                                                         marketing female condom program8 in Zimbabwe is bearing its                                      tried it. As a positive woman I must use one. But I also         The implementing organizations involved in this guide have
     condom programmers often work in environments where there                                                      fruits: female condom sales have increased from 120,720 to 2.1                                   advise others to do so. I talk about it with my friends.         aimed to document and share their experiences with current
     is aversion, even outright hostility, towards the female condom                                                million between 1997 and 2010. PSI Zimbabwe has trained over                                     Without the condom the diseases would spread too fast            and future implementers of large-scale female condom
     as a contraceptive method, because openly discussing sex - and                                                 2000 hairdressers and barbers since the inception of the Hair                                    and young girls get pregnant. There is a huge need for this      programs, so that more women and men around the world will
     women’s sexuality in particular - is taboo. This makes female                                                  Salon Initiative in 20029. The female condom is also distributed                                 female condom.”                                                  have access to the female condom. All who have contributed are
     condom promotion difficult and exciting at the same time, which                                                to over 105 sex worker groups and over 50 people living with                                                                                                      convinced of the great potential that female condoms have in
     only strengthens our devotion to our cause: there is an urgent                                                 HIV (PLHIV) support groups.                                                                                                                                       offering women and girls the opportunity to protect themselves
     need for female condom promotion so that more people will                                                                                                                                                    The guide starts off with a general chapter that outlines all       against unwanted pregnancy and Sexually Transmitted
     know of it, accept it, and have access to it.                                                                  In Mozambique, three organizations—PSI Mozambique,                                            aspects of female condom programming from start to finish.          Infections (STIs), including HIV/Aids. We sincerely hope that this
                                                                                                                    Fórum Mulher and Pathfinder International–are in a unique                                     This chapter is followed by seven thematic chapters that            guide will help you in contributing to the expansion and success
     In Cameroon, Lily Claire Ekobika and Hervé Roger Ngueche                                                       consortium to jointly implement a large-scale female condom                                   further extrapolate on the distinct aspects of female condom        of large-scale female condom programming worldwide. Let’s
     of Association Camerounaise Pour le Marketing Social (ACMS)                                                    program. This is paying off: all three organizations bring in their                           programming:                                                        make the female condom available, accessible and affordable
     and their colleagues work with hairdressers, civil society-based                                               own expertise, which contributes to the success of all aspects                                • Governance: how can your program be governed effectively?         for all!
     organizations and media to promote the female condom as a                                                      of the program. Dorien, Maira, Margarida, their colleagues and                                • Community approaches: how to reach out to potential users
     reliable family planning tool to both men and women. Because                                                   their organizations are very devoted to introducing the female                                   within the communities?
     of them, and all of their colleagues and partners, 773,321 female                                              condom to the people of Mozambique.                                                           • Communication: what are the different communication
     condoms were sold in Cameroon in 2010 6 , less than two years                                                                                                                                                   methods to educate, inform and communicate about the                Mercy Aigbe, traditional midwife
     after the start of the large-scale female condom program.                                                      These female condom programmers in Cameroon, Nigeria,                                            female condom?                                                      Benin City, Nigeria, 2 November 2009
                                                                                                                    Mozambique and Zimbabwe face some of the same challenges,                                     • Advocacy for female condom promotion: how to set up an               “I help women deliver their children. Women are having
                                                                                                                    but also very different ones, depending on the setting in which                                  advocacy strategy and work towards creating a supportive            too many children here. Every year the women come
                                                                                                                    they work. Most importantly, all of them have a passion for the                                  environment for female condom promotion?                            back with another child. The female condom can give
                                                                                                                    female condom and sincerely believe that female condom use                                    • Procurement and supply chain management: everything                  us the space. Space to not have children in too quick
                                                                                                                    ultimately improves couples’ sexual and reproductive health.                                     about purchasing, shipping, storing, and distributing the           succession! You prevent pregnancies; you can practice
                                                                                                                    Their experiences are included in this guide, so that their                                      female condom.                                                      family planning. I’m all for using them.”
                                                                                                                    stories will help you anticipate challenges and opportunities                                 • Male involvement: strategies to reach out to men in female
                                                                                                                    as best as you can when implementing a large-scale female                                        condom promotion.
                                                                                                                    condom program.                                                                               • Creating demand, increasing access: how to create demand
                                                                                                                                                                                                                     and increase access to the female condom by strengthening
                                                                                                                                                                                                                     the different sectors?

                                                                                                                         Elvis Oviasuyi, pharmacist
                                                                                                                         Benin City, Nigeria, 2 November 2009                                                     Let’s be realistic!
     Aunty Queen Beauty Salon in Buea, Cameroon. Mama Odilia selling                                                     “We use it because we think it’s fun, but it also comes in                               In female condom programming, it is important to set realistic
     female condoms in her salon                                                                                         handy in family planning. We have three children, still                                  goals for yourself. Most often, the female condom is a relatively
                                                                                                                         young; that’s plenty for us.”                                                            new and unknown product. This means that it will take some
                                                                                                                                                                                                                  time before people get to know, try and use it. Large-scale
                                                                                                                                                                                                                  female condom programming benefits the entire sexually active
                                                                                                                                                                                                                  population. However it is recommended to start off by focusing
       6 ACMS UAFC Joint Programme Annual Narrative Report 2010.
       7 SFH 2011: Report of the 2011 MAPS Study on the Availability of the Female Condom in Lagos, Edo and Delta states.                                                                                         on several specific regions, or even simply by piloting a small-
       8 At the same time, there is a national condom program through the public sector. In 2009, a total of 4.7 million female condoms were distributed through both the public and social marketing channels.
       9 Center for Health and Gender Equity. Female Condoms and U.S. Foreign Assistance: An Unfinished Imperative for Women’s Health. Washington, DC: Center for Health and Gender Equity, 2011, page 37.
                                                                                                                                                                                                                  scale version of the envisioned program. In the beginning you       Educational material FSH, Nigeria




10                                                                                                                                                                                                                                                                                                                                                         11
     Chapter 1. Process
     Process: Planning, implementing, monitoring and evaluating      1. Introduction: The complexities of female condom                  2.Planning phase: Planning your female condom program10                                                         implementing organizations and target group(s) to involve in
     your female condom program                                      programming                                                                                                                                                                         your program. Additionally, it is at this time that you will start
     In this guide, we aim to describe in detail all the different   When it comes to the design, planning, implementation,              2.1 Preparation                                                                                                 with the procurement and supply chain management of the
     elements of female condom programming. This chapter             monitoring and evaluation of a female condom program, it does       This phase precedes the very first planning of your female                                                      female condoms, as this process tends to be very tedious and
     will outline the design and implementation of your              not necessarily require you to follow an intrinsically different    condom program. At this time, you will establish your project                                                   may take many months to execute effectively.
     female condom program step by step, from planning to            process from the one that you would use in other programming.       team and supervisory body. You will also conduct a thorough
     implementation and from monitoring to evaluation. The           Nonetheless, the multifaceted nature of female condom               stakeholder analysis, which will help you to determine which
     order in which the process is presented by us here is not       programming tends to make it a bit more complex. Female
     necessarily chronological. We merely mean to give you an        condom programming is twofold. On the one hand, it focuses
     overview of possible timelines as well as necessary steps.      on increasing acceptability and encouraging normalization
     We aim to be as realistic as possible in the time frame         of a stigmatized product. On the other, it should make sure to       Planning phase: 1.1 Preparation
     that we offer you. Nonetheless, it is important to note that    facilitate proper procurement and supply chain management
     each female condom program is unique and will have its          to ensure reliable access to the product. These represent two        Preparatory activity                               Explanation                                                                                                                            Time frame11
     own unique features that will sometimes greatly impact          very different levels that female condom programming should
     progress—positively as well as negatively. Some steps           both emphasize. Both are complicating factors that have an           Mapping the needed                                 The operational team needs expertise in:                                                                                               2 months
     discussed in this chapter, and in this guide in general,        influence on how the program should be designed and require          expertise in your
     will be generic for all female condom programming. Other        you to work with as many stakeholders as possible in order           operational team                                   Advocacy – Data collection and documentation - Project management –
     steps will be specifically relevant for some female condom      to maximize impact. Additionally, large-scale female condom                                                             Research – Procurement and supply chain management – Communication
                                                                                                                                                                                             - Report writing and financial management - Material development
     programs, but not for others. In order to provide you with      programming is new to most countries. Hence, it is important
                                                                                                                                                                                             (communication and promotional) - Community mobilization - Capacity
     the full overview, we have assumed that your organization       to set realistic goals for yourself and to emphasize proper
                                                                                                                                                                                             building / training - Fundraising12.
     is starting from scratch. We have also assumed that funding     monitoring and evaluation in order to convince government,
     to design and implement a female condom program has been        donors and communities of the importance of female condom
                                                                                                                                          Involving relevant                                 In order to get the necessary support to implement your program, consulting                                                            4-6 months
     secured already. Hence, fundraising is not addressed here.      programming.                                                                                                            relevant stakeholders and initiating a dialogue with them at an early stage is
                                                                                                                                          stakeholders
     Also, the amount of funding available to you will largely                                                                                                                               very important. Relevant stakeholders may include: Government (national and
     determine the choices you may make with regard to the                                                                                                                                   local government) – UN agencies - Private sector companies - Gate keepers –
     design and implementation process.                                                                                                                                                      Community leaders - Support groups.
                                                                        Lilian Tamako, 25 years old, student nurse
                                                                        Bamenda, Cameroon, 2 November 2010                                Establishing a supervisory                         Mapping relevant members, approaching them, agreeing on roles and                                                                      4-6 months
                                                                                                                                          body                                               responsibilities.
                                                                        How did you first learn about the female condom?
                                                                        “I tried it for the first time about four years ago. I did not    Involving the target                               Planning meetings and advocacy visits with, for example:                                                                               3 months
                                                                        like it very much at that time but later I realised that I        group(s)                                           Men and women who are sexually active, groups that represent specific target
                                                                        bought the condom without really knowing how to use it.                                                              groups like women associations, transport workers, out-of-school male and
                                                                        After that first experience I didn’t see the condoms for a                                                           female youth, men and women in unions, people living with HIV (PLHIV),
                                                                        while. Last year all of a sudden they were back. I met a                                                             female sex workers and their clients, men and women in uniform, mobile
                                                                                                                                                                                             workers and their partners.
                                                                        group of peer educators at the market talking to a group
                                                                        of women. I stopped to listen. They demonstrated how
                                                                                                                                          Procurement and Supply                             The procurement of the female condoms needs to be ensured before the                                                                   6 months
                                                                        to use it and so I learned. After that I tried it again and it
                                                                                                                                          Chain Management (PSM)                             project is rolled out. Usually during the first 6 to 12 months, the program will                                                       before the
                                                                        was a lot easier for me.
                                                                                                                                          of female condoms                                  work with generic female condoms13 while awaiting the arrival of your own                                                              start of project
                                                                                                                                                                                             branded female condoms for social marketing purposes. Please note that it is                                                           implementation
                                                                        So I would say that my first experience was not really                                                               important to involve the relevant national regulating body in this process to be
                                                                        good but the second experience was different because of                                                              sure to work according to local laws and regulations.
                                                                        the educators and so I learned to like it.”
                                                                                                                                          Total time frame                                                                                                                                                                          6-12 months
     Demonstrating the female condom on the market in Nigeria




                                                                                                                                           10 Please note that the order in which the different steps are presented do not necessarily imply chronology. Furthermore, the list of steps is not exhaustive and the relevance of the different steps depends on
                                                                                                                                              the context in which you will be implementing your program.
                                                                                                                                           11 We have aimed to estimate the time frame needed as realistically as possible, based on the experiences of our implementing partners in four different countries. Nonetheless, the time needed to execute
                                                                                                                                              the different steps may vary greatly from context to context. Activities can run simultaneously.
                                                                                                                                           12 Even if your program is fully funded already, it makes sense to continue to raise funds for additional projects or the continuation of the program once the project phase has come to an end.
                                                                                                                                           13 By referring to “generic” female condoms, we mean the type of female condom that is carrying the manufacturer’s brand. In the case of the FC2 this refers to the FC2s that have been branded by the Female

                                                                                                                                              Health Company. In most cases, female condom programming will start off using whatever type of female condom is already available in the country, in warehouses or in the pipeline. These need to be
                                                                                                                                              promoted and sold first before procuring new stocks.




12                                                                                                                                                                                                                                                                                                                                                              13
     2.2 Research                                                                                                   is important to understand the broader context including the                                   2.3 Formulating objectives and indicators
     Prior to designing your program, it is extremely important to                                                  service delivery system, socio-cultural environment, as well as                                Based on the outcomes of your needs assessment and
     conduct thorough research on the current situation in your                                                     the political context. Furthermore, a mapping of existing policy                               situational analysis, you can start designing your program
     country in relation to HIV/Aids, STI prevalence, unintended                                                    frameworks and implementation activities needs to be done in                                   framework. What is the ultimate goal of your program? And
     pregnancy rates, sexual and reproductive health, contraceptive                                                 order to avoid working in isolation and to ensure the best fit of                              what are the specific objectives?17 These may be supported by a
     use, and target groups. Before starting your program, you need                                                 your female condom program within the larger framework.                                        log frame that lists outputs, outcomes, objectives and indicators,
     to gain insight into the need for the female condom of potential                                                                                                                                              methodologies, and strategies.
     users within different target groups, to what extent they                                                      Your research and data collection should be based on:
     may have access to sexual and reproductive health services
     already and the kind of information and contraceptives that                                                    • Needs assessment, situational analysis (primary data                                          Planning phase: 1.3 Formulating objectives and indicators
     are already available to them. A proper situational analysis                                                     collection)
     will offer legitimacy to your female condom program and helps                                                  • Literature review, policy review (secondary data collection)                                  Formulating objectives                            Explanation                                                                       Time frame
     you to gain insight into who you should target. In addition, it                                                                                                                                                and indicators activity

                                                                                                                                                                                                                    Developing your program                           Your program plan describes the justification of the program, its duration,       3 months
      Planning phase: 1.2 Research
                                                                                                                                                                                                                    plan                                              planned activities, expected outcomes, division of responsibilities, and budget
                                                                                                                                                                                                                                                                      lines. The development of your program plan should be a participatory process
      Research activity                                 Explanation                                                                                                                           Time frame                                                              that involves all stakeholders and implementing partners.

      Primary data collection14                         Your primary data collection will significantly contribute to the                                                                     4-8 months            Developing a logical                              A logical framework/dashboard is a planning, monitoring and evaluation tool       1 month
                                                        justification of your female condom program: it will argue in favor of                                                                                      framework/dashboard                               that requires you to describe the overall goal, outputs, outcomes, objectives
                                                        your program’s contribution to improving sexual and reproductive                                                                                                                                              and indicators, and means of verification of your program.
                                                        health, family planning options, HIV/Aids infection rates, and the gender
                                                        situation in your country. This will legitimize your overall program design.
                                                                                                                                                                                                                    Total time frame                                                                                                                    4 months
                                                        Your situational analysis15 should include:

                                                        Female Condom Coverage Survey

                                                        A coverage survey to measure:
                                                        1. Current availability of the female condom in outlets and public health
                                                           clinics, indicating the access to the female condom.
                                                        2. Quality of the current availability: in terms of quality of the outlet/public
                                                                                                                                                                                                                      Cypra Yamsu, Young Job Seeker, Regular User. Buea,
                                                           health clinic, supply and stock outs, availability of promotional and
                                                           educational materials and the price of the product, indicating the quality of                                                                              Cameroon, 5 November 2010
                                                           access to the female condom.
                                                                                                                                                                                                                      Cypra, have things changed for you since you started
                                                        Your needs assessment should include:                                                                                                                         using the female condom?
                                                                                                                                                                                                                      “I can tell you that things have changed a lot. I have
                                                        A KAP/KAB study16 assessing the target group’s / groups’:                                                                                                     actually had a wonderful experience using the female
                                                        • Knowledge about the product, availability / where to obtain the product,                                                                                    condom. I can actually protect myself and be very sure
                                                           and knowledge on how to use it.                                                                                                                            of such protection. I’m confident telling other women
                                                        • Attitude, including perception, behavior, motivation, acceptance, enabling                                                                                  about it.”
                                                           environment, and social support.
                                                        • Practice/Behavior addressing the level of use of the product.
                                                                                                                                                                                                                      Had both of you been using the male condom before?
                                                                                                                                                                                                                      “No. Our sex life was not really good because he never
      Secondary data collection                         This desk study consists of an analysis of existing programs and policies that                                                        1 month
                                                                                                                                                                                                                      liked using condoms. For that reason I was never really
                                                        address female condom use, sexual and reproductive health, family planning,
                                                        and HIV/Aids prevention. Some governments have national condom strategies.                                                                                    interested in sex because he travels a lot and I am not                                 Educational material FSH, Nigeria
                                                        This analysis will help in integrating your female condom program into                                                                                        sure what he does when he travels and things like that.
                                                        existing policy and program frameworks in order to increase your program’s                                                                                    As a matter of fact, one time the male condom burst
                                                        sustainability.                                                                                                                                               and I was scared and traumatised for months! But
                                                                                                                                                                                                                      since we started using the female condom nothing like
      Total time frame                                                                                                                                                                        4-9 months              this has ever occurred and so I am now comfortable
                                                                                                                                                                                                                      with sex again.”

       14 If sufficient funding for a KAP/KAB and Coverage study which is more comprehensive is not available to you, market research is also an option for the socially marketed female condom in order to get
          information concerning Willingness to Pay, user profiles, brand positioning, and segmentation by way of e.g. a focus group study combined with in-depth interviews. This will help in structuring your
          communication strategy and marketing plan. This research can be executed by the lead organization itself, or a local/national (market) research firm or consultant may be contracted.
       15 Refer to Bibliography and Further Reading for situational analysis tools.
       16 See Annex 1 for Focus Group Discussions Guides with current users, and current non-users of the Female Condom.                                                                                             17   Refer to Annex 2 for an example of female condom programming goal and objectives.




14                                                                                                                                                                                                                                                                                                                                                                   15
     2.4 Program design
     After the first round of preparatory activities, you may start
     designing your program starting from the goal and objectives
     that you have formulated.



      Planning phase: 1.4 Program design

      Program design activity                            Explanation                                                                                                                     Time frame             Developing promotional                             Promotional materials20 may include: leaflets, posters, flip charts, training   3 months
                                                                                                                                                                                                                materials and training aids                        manuals and guides. Modules should be developed based on the following
      Baseline study                                     A baseline study will help you to assess the current situation in relation                                                      2 months                                                                  behavioral determinants:
                                                         to your specific objectives. In the monitoring and evaluation of your                                                                                                                                     • Knowledge: about the female condom and how to use it properly;
                                                         objectives you will then be able to demonstrate improvement that you may                                                                                                                                  • Social influence: social acceptance and how to attain it;
                                                         claim as a success of your program.                                                                                                                                                                       • Attitude: how to develop a positive attitude to avoid and address
                                                                                                                                                                                                                                                                      misconceptions about the female condom;
                                                         Baseline studies may include:                                                                                                                                                                             • Skills: how to use the female condom and how to negotiate condom use.
                                                         • Multiple Indicator Cluster Surveys (MICS)18;
                                                         • Household surveys;                                                                                                                                                                                      Promotional materials should be pre-tested with your target group(s). Make
                                                         • Demographic and Health surveys.                                                                                                                                                                         sure to allow sufficient time for this process.

      Annual (and quarterly)                             Based on your program plan, specific work plans need to be written                                                              1 month                Monitoring and Evaluation                          Your monitoring and evaluation plan needs to describe your program’s            1 month
      work plans                                         explaining the activities that you have planned, the estimated timeline,                                                                               (M&E) plan and tools                               objectives and indicators and how these will be monitored. It should
                                                         budget, and how the activities relate to the overall goal and objectives of                                                                                                                               also describe the outcomes of your baseline study, a mid-term review (if
                                                         your program.                                                                                                                                                                                             applicable), an end evaluation, and should provide monitoring tools21.

      Selecting and building                             CBOs, lead trainers and peer educators are selected based on their skills,                                                      2-3 months             Advocacy strategies and                            Creating a supportive and sustainable environment for female condoms            1 month
      the capacity of CBOs, lead                         capacity and geographic locations. Memorandums of Understanding                                                                                        sustainability                                     requires advocacy strategies that target the right influential people with
      trainers, peer educators                           (MoUs) should be signed with selected CBOs.                                                                                                                                                               convincing messages22. Their support is needed for your program to be
                                                                                                                                                                                                                                                                   implemented successfully, but also for the integration of female condom
      Marketing plan, including                          The marketing plan is based on research, often carried out by an external                                                       Developing the                                                            programming into existing programs and policies.
      communication and                                  marketing firm.                                                                                                                 marketing plan: 2
      branding strategies                                                                                                                                                                months                                                                    Key stakeholders may be offered a seat in your supervisory body.
                                                         Marketing19 is about the following elements:
                                                         • Branding: it creates appeal and assures quality;                                                                              Registration process   Procurement and Supply                             Supply chain management is about effective distribution of female               International
                                                         • Price: an attractive price is an incentive, both for the buyer and the                                                        needs to commence      Chain Management (PSM)                             condoms from state level, to community level, and to outlets. Your PSM          procurement should
                                                           seller;                                                                                                                       at least 6 months      plan                                               plan should describe the procurement, packaging, testing (if applicable),       be sorted out at
                                                         • Placement: is about getting the product at the right place and the                                                            prior project                                                             and transportation.                                                             least 6 months prior
                                                           right time by way of effective distribution channels and supply chain                                                         inception so as to                                                                                                                                        to program roll-out.
                                                           management;                                                                                                                   avoid delays when
                                                         • Promotion: promoting the female condom increases uptake and allows                                                            securing approval      Documentation tools                                To capture lessons learned and to document the process properly,                1 month
                                                           for knowledge to be shared.                                                                                                   for branding.                                                             documentation tools need to be in place for the lead organization to keep
                                                                                                                                                                                                                                                                   track of program documentation.
                                                         Communication strategies towards the user may be part of your marketing
                                                         plan. Alternatively, they may be developed separately based on data on                                                                                 Total time frame                                                                                                                   6 months
                                                         the profile of the target group(s), languages used, communication channels
                                                         used, literacy level, and what messages you want to communicate to
                                                         people.




       18 MICS are a tool for collecting and analyzing data in order to fill data gaps for monitoring the situation of children and women by way of an international household survey.                          20   Refer to chapter 4: How to communicate with potential users.
          Please refer to: http://www.unicef.org/statistics/index_24302.html                                                                                                                                    21   Refer to Bibliography and Further Reading for M&E tools.
       19 Refer to the chapter 4: How to communicate with potential users and chapter 8: Creating Demand, Increasing Access.                                                                                    22   Refer to the chapter 5: Advocacy towards decision makers and Bibliography and Further Reading for more information.




16                                                                                                                                                                                                                                                                                                                                                                        17
     3. Implementation phase: Implementing and monitoring                                                       running according to plan. Needless to say, there should be a       Advocacy towards                         Advocacy is a process that aims at generating support, promotion        Developing your advocacy
     your female condom program                                                                                 close link between implementation and the program’s overall         decision makers                          and funds for your female condom program by attempting to               strategy: 1 month
                                                                                                                goal and objectives. Hence, assessment of your strategies                                                    strategically influence decision makers, such as community leaders
     When all preparatory work is done and your program has been                                                and time frame is essential to make sure that you are on the                                                 and other gatekeepers, government officials, and institutions.          Advocacy activities: ongoing
     properly designed, implementation of the activities may start.                                             right track. A feedback loop should be created that allows                                                   A positive attitude towards the female condom and its benefits
     You can choose to first pilot the program in a specific area,                                              for changes and improvement in the project cycle. A proper                                                   therefore needs constant sensitization and engagement of influential
     which you go on to evaluate. Based on the lessons learned you                                              reporting system will contribute to your data collection and                                                 leaders in society.
     may expand the reach of your program implementation.                                                       improvement of the overall program. Monitoring is done
                                                                                                                through regular supervisory visits on implementation level and      Procurement and                          The female condom needs to be available for the user. Procurement       Procurement: as of 6 months
     While implementing, your program needs to be closely                                                       should entail the collection of both qualitative and quantitative   Supply chain                             and Supply Management is about purchasing the female condoms            prior to the start of program
                                                                                                                                                                                    Management (PSM)                         from the manufacturer, shipping them to your country, storing them      implementation
     monitored to oversee whether or not the interventions are                                                  data.
                                                                                                                                                                                                                             in warehouses and depots, and organizing the logistics to get the       & ongoing
                                                                                                                                                                                                                             female condoms to outlets, CBOs and peer educators. The “pipeline”
                                                                                                                                                                                                                             must be stocked at all times, meaning that all channels in the supply
      Implementation phase23                                                                                                                                                                                                 chain (warehouses, depots, outlets, peer educators and CBOs)
                                                                                                                                                                                                                             should be permanently stocked. This means that you will need to
      Implementation or                         Explanation                                                                                    Time frame                                                                    purchase more products than you are expected to sell or distribute.
      monitoring activity                                                                                                                                                                                                    Distribution can be done in several ways: free distribution, giving
                                                                                                                                                                                                                             samples, selling subsidized products, or selling at a profit.
      How to govern your                        Implementing a female condom program requires a solid governance                               Supervisory body meetings:
      female condom                             structure that includes stakeholders who represent and have access                             every 3 months                       The involvement of                       Involving men in sexual and reproductive health matters has             Ongoing
      program?                                  to different groups in society. The governance structure may consist                                                                men                                      advantages over exclusively focusing on women, e.g. the genuine
                                                of an operational team (lead organization, CBOs, peer educators) and                           Review meetings with lead                                                     protection of the couple and the family will be encouraged, respect
                                                a supervisory body that oversees the overall program.                                          organization, CBOS, lead trainers                                             for the woman by the man will increase, gender equality will be
                                                                                                                                               and peer educators: every 3-6                                                 promoted, and a higher acceptance of the product by both men and
                                                                                                                                               months                                                                        women will likely be achieved. Hence, promotional events should
                                                                                                                                                                                                                             reach out to men and women equally.
      Community                                 Promoting female condom use requires collaboration with                                        Training-of-Trainers for lead
      approaches                                individuals that are part of the communities that you are targeting,                           trainers and CBOs takes place for    Creating demand,                         There are different ways to promote the female condom to women          Ongoing
                                                so that they may invest in educating, counseling and selling the                               a total of 3-5 days.                 increasing access                        and men. There is the non-commercial or public sector that makes
                                                female condom to potential users. These individuals may be found                                                                                                             the female condom available in public centers like clinics, family
                                                by consulting with civil society implementing partners, private sector                         Training of peer educators:                                                   planning centers, HIV/Aids voluntary counseling and testing centers,
                                                partners, and public sector partners. Their competencies with regard                           1-2 days.                                                                     and by some NGOs/CBOs. Additionally, there is the private sector
                                                to educating about and demonstrating female condom use should be                                                                                                             that sells the female condom for a profit and is often based on
                                                built.                                                                                         Review meetings with lead                                                     rebranding campaigns to attract the consumer. Finally, there is
                                                                                                                                               organization, CBOS, lead trainers                                             the social marketing approach that creates access by offering the
                                                                                                                                               and peer educators: every 3-6                                                 product for a subsidized price or by giving out free samples. The
                                                                                                                                               months.                                                                       different sectors complement each other in creating access to the
                                                                                                                                                                                                                             female condom.
      How to                                    The (potential) user of the female condom needs accurate messages                              Peer educators start their
      communicate with                          about the female condom and its use as well as the skills to try                               promotional events soon after        Monitoring                               Coverage survey: The availability and quality of availability of the    Annually
      potential users?                          and use it. The user needs to be identified as the target audience.                            their training is finished.                                                   product should be monitored in order to assess impact.
                                                Different target audiences may be reached through a range of                                                                                                                                                                                         Every 3 months
                                                communication strategies, such as sensitization meetings, inter-                               Engaging role models:                                                         Reporting: Different stakeholders will report on their specific
                                                personal communication by a peer educator, road shows, use of                                  6 months                                                                      activities that are related to the program outputs and outcomes. A      2 months
                                                media channels and handing out leaflets. The peer educator needs                                                                                                             proper reporting format will help you to make sure that you collect
                                                promotional tools such as a vagina demonstration model, posters,                               Developing media messages:                                                    the most relevant information from all stakeholders, so that you may
                                                flip charts, and samples of the female condom. Rebranding the                                  1 month                                                                       timely adapt your program indicators and activities.
                                                female condom may attract more users.
                                                                                                                                               Engaging media: ongoing                                                       Mid-term review: When project implementation is halfway, it is
                                                Media plays a role in generating positive attitudes of the general                                                                                                           helpful to assess your achievements to find out whether objectives
                                                public towards the female condom by disseminating accurate,                                    Training journalists: 1-2 days                                                and indicators are realistic or need adjustments.
                                                positive and attractive messages. Characteristics of a media
                                                strategy include: developing messages, engaging role models in the                             Workshop with media directors:       Total time frame                                                                                                 Depending on your program’s
                                                promotion of female condom use, and building the capacity of media                             1 day                                                                                                                                                 overall duration
                                                staff to convey correct and consistent messages.




       23   The elements in the program design are thoroughly described in the thematic chapters that follow.                                                                       24   Refer to Bibliography and Further Reading for M&E tools.




18                                                                                                                                                                                                                                                                                                                                   19
     4. Evaluation phase: Evaluating your female condom
     program

     When your program is coming to an end, an extensive
     evaluation will help to assess whether your program
     interventions have actually contributed to the overall goal
     and objectives that you stated. Evaluation outcomes may
     also provide you with a rationale for the continuation and
     sustainability of the program as is or, alternatively, will offer you
     suggestions with regard to how to adapt your program in order
     to make it more effective and to attract new or more funding.




      Phase 6. Evaluation

      Evaluation activity                Explanation                                                                          Time frame

      End Evaluation                     At the end of the program, achievement of program goal and objectives should         3 months
                                         be evaluated. Your end evaluation may offer you suggestions for adaptations of
                                         the program, or will legitimize a call to continue your program.

      Total time frame                                                                                                        3 months




                                                                                                                                                   Paper dolls in front of the United Nations
                                                                                                                                                                                 in New York




20                                                                                                    Promotional materials UAFC Joint Programme                                                21
                                                     Chapter 2. How to govern your female condom program
                                                     Implementing female condom programming requires                           A good way of building a varied stakeholder base is by
                                                     a governance structure that includes stakeholders                         including them in the program governance structure. This will
                                                     who represent and have access to different groups                         allow them to meaningfully participate in advising on and/
                                                     in society. The operational team is responsible for                       or implementing the program. Giving them a stake in decision
                                                     program management and the monitoring of program                          making will generate a sense of ownership and will encourage
                                                     implementation on community level. The supervisory                        active engagement. Getting these stakeholders on board and
                                                     body is responsible for advising the operational team and                 work together is a complex process. However, once all different
                                                     should ideally advocate for the female condom among                       parties have been found willing to cooperate, this will maximize
                                                     their constituencies. This chapter describes the roles and                female condom acceptance at different levels and among
                                                     responsibilities of the operational team—including the                    different groups in society.
                                                     lead organization, the CBOs, and peer educators—and of
                                                     the supervisory body.                                                     Design of your governance structure will depend on the
                                                                                                                               specifics of your program and political context in which you are
                                                                                                                               working. Nonetheless, there are some good examples of existing
                                                     1. Introduction: How to build for responsibility and                      female condom program governance structures. We will share
                                                     commitment                                                                these with you in this chapter while we discuss the different
                                                     Successful female condom promotion requires the on-going                  partners and stakeholders that may be part of your governance
                                                     support of a broad range of stakeholders in order for it to               structure, the way in which they may relate to one another, and
                                                     become accepted by government, community leaders, other                   what particular opportunities and challenges are that you may
                                                     gatekeepers, CBOs, peer educators and, ultimately, potential              encounter in the process.
                                                     users. Getting a broad range of stakeholders on board will help
                                                     you to gain access to their varied constituencies and will allow
                                                     you to reach out to as many people as possible that may benefit
                                                     from using the female condom.




                                                                                                                     National
                                                                                                                 Supervisory Body




                                                                                                                Lead Organization




                                                              Region 1                                                  Region 2                                             Region 3


                                                           Regional Team                                  Regional Team                                 Regional Team
                                                         Lead Organization           CBO’s              Lead Organization           CBO’s             Lead Organization            CBO’s




                                                                    Peer Educator                                  Peer Educator                                   Peer Educator




                                                                                       Regional                     Regional                       Regional
                                                                                    Supervisory Body             Supervisory Body               Supervisory Body




22   Demonstration of female condom use in Nigeria                                                                                                                                                23
                                                                                                                                                                   Case Study                                  Mozambique

     2. Operational team: Fruitful cooperation is the key to              As a collective, the operational team should have joint
     success                                                              expertise in communications, procurement and supply chain
     The organizations and individuals that will actually implement       management, social marketing, Sexual and Reproductive Health        In Mozambique, the three organizations including Fórum                                                    •	 PSI/Mozambique is experienced in supply chain
     your female condom program on a daily basis are key in your          and Rights (SRHR), Family Planning, HIV/Aids programming,           Mulher, Pathfinder International and PSI/Mozambique have                                                     management, and social marketing.
     governance structure. They are the ones that coordinate, train,      women’s empowerment and women’s rights, financial and               been collaborating with the Female Condom Consortium to
     advocate, supply and reach out to users. The operational team        program management, and advocacy.                                   implement a large-scale female condom program. During                                                     While PSI/Mozambique is the lead organization in the
     may consist of the following organizations and individuals:                                                                              the initial phase of the writing of the proposal, these three                                             Consortium, implying that it carries the main financial and
     • The lead organization(s) that coordinate(s) your program.                                                                              organizations came together because they complemented each                                                reporting responsibilities, the responsibility concerning the
        The lead organization(s) may have regional teams or offices       2.1 Lead organization                                               other’s expertise in a very effective manner:                                                             implementation of the different components was allocated
        for the purpose of overseeing regional activities.                The lead organization is responsible for the operational design,                                                                                                              to these three organizations according to their expertise. In
     • Community-Based Organizations (CBOs). They play a pivotal          implementation and monitoring of program activities vis-à-vis       •	 Fórum Mulher is strong in advocacy for gender equality                                                 the beginning, the consortium had to invest time in building
        role in translating the overall objectives of your program into   the donor(s). Financial and narrative reporting is therefore the       and women’s rights, and has a substantial network of local                                             trust, and agreeing upon roles and responsibilities. Now, the
        real goals that are meaningful within the given communities’      responsibility of the lead organization. In most cases, they will      member organizations,                                                                                  consortium sees many advantages in working together in terms
        daily realities.                                                  be the one that is reporting to the donor. The lead organization    •	 Pathfinder International has expertise in working with the                                             of division of labor, a more diversified access to communities
     • Peer educator representatives. They work on community              should be able to coordinate and communicate with a variety            public sector and in the capacity building of technical health                                         and government and an increasingly efficient impact in the
        level and have face-to-face contact with the (potential) users    of partners and stakeholders, from the supervisory body, to            care staff and community outreach,                                                                     different components of the program.
        of the female condom.                                             CBOs and peer educators. It should have a good network and
                                                                          expertise in financial and program management specifically. In
                                                                          terms of structure, the lead organization may appoint a program
                                                                          coordinator to oversee full implementation of the program, in
                                                                          addition to local teams that are responsible for implementation
                                                                          in different areas. Depending on their locations, either regional
                                                                          program officers or a central level program coordinator             2.2 Community-Based Organizations (CBOs)26
                                                                          will maintain contact with the CBOs and peer educators on           CBOs play an important operational role in running your                                                      Pastor Chibuike Amaechi, state co-coordinator and member
                                                                          community level.                                                    program within the communities. The involvement of these                                                     of the steering committee female condom in Lagos, director
                                                                                                                                              types of organizations is invaluable as they have the local                                                  of health NGO the Good Neighbor.
                                                                          The lead organization should make sure to formally engage           knowledge, networks, as well as language proficiency that is                                                 Mushin, Lagos, Nigeria, 29 October 2009
                                                                          CBOs and peer educators by clearly defining their roles,            needed to make your program successful. In this regard, it is                                                “Our concern here is with the women dying in labor.
                                                                          responsibilities, and by making them aware of how they may          highly recommended to have the lead organization actively                                                    That happens too often. So we asked ourselves: How can
                                                                          voice their opinions on the overall program management.             engage its CBO partners in the overall monitoring, evaluation                                                we save the lives of young mothers? We use the female
                                                                          This can be done by way of formally agreeing on a Terms             and decision making regarding the program. For example: CBOs                                                 condom to achieve this. Women can use it themselves;
     Demonstration of female condoms                                      of References (ToR) or by signing a Memorandum of                   may be invited to monthly review meetings, staff retreats and                                                they are in charge of their pregnancies.
                                                                          Understanding (MoU). Monetary and material incentives need to       meetings with the supervisory body. CBOs are the ones that can
     Meaningful participation of all partners (lead organization,         be agreed upon and formally documented by way of invitation         recount success stories and, perhaps even more importantly,                                                  Many women have a child every year and 15 percent of
     implementing partners and other relevant stakeholders) within        letters and by keeping and confirming minutes of planning           can document challenges encountered while implementing the                                                   mothers die in labor. Our healthcare system is so bad. I
     the governance structure will encourage them to continuously         meetings. Evidence of payments must be documented by way            program on the ground and reaching out to (potential) female                                                 see in my neighborhood how things go; it’s frightening for
     support and sustain your female condom program. Participatory        of a receipt administration. Local NGOs/CBOs may be engaged         condom users. It is most important to address these challenges                                               everybody. So if you could prevent half the pregnancies,
     program planning, on-going training opportunities, involvement       by funding them and/or by offering them capacity building           and successes in order to continuously keep improving your                                                   you’d save hundreds of lives. With the female condom
     in review meetings, regular refresher training, and feedback         sessions and by providing them with adequate products and           program. Also, involving your local partners in retreats and                                                 women’s life expectancy would increase.”
     on staff performance are all means to motivate CBOs and peer         promotion materials.                                                other meetings will strengthen their capacity and nurture their
     educators to continue to be committed to your program. All                                                                               engagement and commitment to make the program successful.
     partners in the governance structure are required to have easy                                                                                                                                                                                     2.3 Peer educators27
     access to transparent and up-to-date monitoring information                                                                              CBOs are involved in the sensitization of communities and                                                 Essential to your governance structure is inclusion of the
     in order for them to be able to meaningfully participate in the         Anonymous, Commercial Sex Worker                                 significantly contribute to creating demand for the female                                                individuals that have face-to-face contact with (potential)
     program25.                                                              Buea, Cameroon, 5 November 2010                                  condom in their area of competence. They may be contracted                                                female condom users. These peer educators share information
                                                                                                                                              for the implementation of your female condom program within                                               and educate users with regard to how to use the female condom.
                                                                             You meet different types of men. Are there some who have         the communities. This means that your CBO partners will incur                                             They do this in face-to-face contact with (potential) users or in
                                                                             rejected the female condom?                                      additional administration costs that are to be covered. In the                                            sensitization meetings with groups of people. They also offer
        Did you know…                                                        “Yes. Many of them refuse. But if they refuse to use it I        Memorandum of Understanding (MoU) signed with the lead                                                    the female condom for sale or distribute it free of charge. Peer
        …That in Nigeria, some faith based organizations                     just leave. It makes me think that they are sick. I’m not        organization, office running costs and administration fees need                                           educators may include CBO staff, hairdressers and barbers,
        educate people about the female condom?                              married. I am a sex worker and our lives are in danger.          to be included. If CBOs are engaged on a voluntary basis, you                                             and people that are part of the communities that you aim to
                                                                             Because I meet many different men, and also certain              may make sure to support them by offering to train them and by                                            target. They are generally identified by the lead organization’s
                                                                             types of men, I am in great risk and I know this. Reject it      providing them with female condoms free of charge.                                                        technical staff. Often, different kinds of peer educators
                                                                             and I reject you too. If they refuse, I go.”

                                                                                                                                                26   See chapter 3: Community Approaches for the role of CBOs in female condom programming.
       25                                                                                                                                       27   See chapter 3: Community Approaches for the role of peer educators in female condom programming.
            Monitoring is described in chapter 1: Process




24                                                                                                                                                                                                                                                                                                                          25
     contribute to the female condom program at the same time.                  of an Advisory Board vis-à-vis the implementing organization
     Either the (regional) lead organization or the CBOs involved are           tend to be much clearer because of its restricted and clearly
     supporting them in their daily activities in support of female             delineated mandate.
     condom use.

                                                                                Points of attention when installing your supervisory body:

                                                                                • Members should be chosen strategically: they will represent
                                                                                  different constituencies and their commitment will create
                                                                                  increased support for the female condom in different
                                                                                  segments of society.
                                                                                • Members should be involved from the very beginning of
                                                                                  the program so as to create mutual understanding of and
                                                                                  commitment towards the program’s objectives.
                                                                                • Encouraging the relevant people to join your supervisory
                                                                                  body will need convincing advocacy efforts, repeated
                                                                                  attempts to get them on board, and some patience. Be sure to
                                                                                  adapt your expectations accordingly.
                                                                                • Members should ideally include government officials,            Promotionteam ETCHU Molyko in Cameroon
                                                                                  both in the policy and program field, (inter)national
     Peer to peer education: Taxi driver explains the benefits and use of the     NGOs, UN agencies, media, and donors. The more diverse
     female condom to his colleagues                                              your supervisory body, the greater the benefits for your
                                                                                  programming.
                                                                                • Members may reach out to other government and civic
     3. Installing a supervisory body                                             leaders and seek additional (financial) support.                Tips & Tricks
     The operational team may be supported by a supervisory body                • The entire supervisory body should meet every few months
     that oversees implementation of your program. The supervisory                with representatives of the operational team or lead            •	 Establish	a	supervisory	body	(Steering	Committee	or	               empowerment, women’s rights, quality assurance, financial
     body does not only advise on how to maximize the impact                      organization to make sure that communication is frequent           Advisory Board), decide on its mandate, and involve the            and program management, and advocacy.
     of your implementation, it also has important added value                    and thorough.                                                      members from the beginning.                                     •	 Engage	CBOs	and	peer	educators	in	the	overall	monitoring,	
     when it comes to advocacy. The members of your supervisory                 • The chair and deputy chair should have more frequent            •	 Make	sure	there	is	adequate	expertise	within	the	operational	      evaluation and decision making of the program by inviting
     board represent distinct groups within society and have strong               contact with the lead organization.                                team with regard to communication, supply chain                    them to frequent review meetings and training sessions.
     networks that they may put to use when advocating for the                  • Different supervisory bodies may exist at different regional       management, social marketing, sexual and reproductive
     female condom. Especially with regard to female condom                       levels. On national level, a supervisory body may be               health, family planning, HIV/Aids, women’s
     promotion, having such “champions” in your governance                        overseeing the entire country program whereas, on regional
     structure is important for the execution and sustainability of the           level, additional supervisory bodies may be installed to
     project.                                                                     oversee the activities in a specific areas.
                                                                                • Statutes should be compiled and agreed upon that indicate
     In terms of your supervisory body, you may choose to install                 the different positions within the body, the names of
     either a Steering Committee or an Advisory Board. The                        the members and their membership duration, and the
     distinction between the two is based on significant differences              expectations of and the roles of each member.
     in their respective mandates.                                              • Members may be paid an allowance in return for the time
                                                                                  they invest in your program. The amount of the allowance        Challenges
     A steering committee may have both an advisory role and a                    allocated may be higher for the chair and the deputy chair as
     decision making role. Equipping your steering committee with a               they likely invest more time than other members do. Signing     •	 A	supervisory	body	will	likely	contribute	significantly	to	        manner will encourage most of them to show active
     decision making mandate is a way to further involve and engage               contracts with them is highly recommended.                         your program’s success, but may also take over control             engagement. All different stakeholders need to be offered
     them. It also offers recognition to its members as equal and                                                                                    regarding decision making and ownership. Make sure to be           incentives for engagement that are meaningful to them.
     important partners in your program, which will contribute to the                                                                                clear about its mandate, role and responsibilities from the     •	 Make	sure	to	design	a	transparent	and	inclusive	governance	
     overall sustainability of your program’s objectives. Nonetheless,                                                                               very beginning and formalize this.                                 structure in which each partner’s role and responsibilities
     roles and responsibilities must be clearly defined and agreed                 Did you know...                                                •	 The	motivation	and	commitment	demonstrated	by	the	                 are clearly stated.
     upon by the Steering Committee and the lead organization that                 ...That the Steering Committee of the UAFC project in             stakeholders in your governance structure may vary.
     is implementing the program. In this process, it is important to              Cameroon is chaired by the Permanent Secretary of the             Involving all stakeholders in a pro-active and transparent
     make sure that enough room is left for the lead organization to               National Control AIDS Committee?
     make its own decisions and to define its strategies.

     An advisory board solely advises the implementing and
     operational team. In this regard, the roles and responsibilities




26                                                                                                                                                                                                                                                                                    27
     Chapter 3. Community approaches
     Successful promotion of female condom use starts at                                                                                    A number of people or organizations are able to reach out to         your target audience and making your program accepted in
     micro-level. Individual mindsets and attitudes need                     Odilia Bessem Kum, Married, Mother of three children           a given community and further your cause of female condom            a community. For example, women’s groups tend to be in a
     to be addressed and changed in order to encourage                       Owner of Beauty Salon                                          promotion:                                                           position to reach victims of gender-based violence as well as
     actual experimentation with the product. This requires                  Buea, Cameroon, 4 November 2010                                • Civil society implementing partners, such as community-            other vulnerable women. Men’s groups can help in promoting
     sensitization of the most subtle kind, which often means                                                                                   based organizations, faith-based organizations, female           the product to fellow men. Faith-based organizations tend to
     that face-to-face and repeated interaction is needed                    How do you promote the female condom?                              condom peer promoters, women, men, and youth group               have a large followership and strong influence on and links with
     to actually reach potential users in a meaningful way.                  “I’ve worked with ACMS for about thirteen months.                  leaders;                                                         their communities. Involving these groups in female condom
     Collaboration with people within the communities who are                Initially, it was not very easy speaking in public and         • Private sector partners, such as hairdressers and                  programming may contribute to the integration of the female
     in a position to invest in education, counseling and sales              demonstrating the artificial vagina. People would just             barbers, pharmacies and drug stores, sex worker networks,        condom into their existing sexual and reproductive health and
     of the female condom is needed. People from within the                  start laughing. When I first started introducing this              manicurists, private clinics, organizations employing men        HIV/Aids programs.
     community speak the appropriate languages, are more                     device to women, many of them said they didn’t like it.            and women, and other female-oriented sales points. Hotel
     accepted, and have networks which can all help to reach                 Others said it was clumsy, while some said it was too big.         managers may also be considered;
     people within communities. The appropriate persons may                  But when I demonstrated how it was used, some of them          • Public sector partners, such as health and family planning
     be identified by implementing partners at community                     started opening up. Some would come to me privately                clinics, health workers, community health workers, HIV              Did you know...
     level. They may help in selecting, training and supporting              and ask me to teach them how to use it.                            clinics, support groups for people living with HIV/Aids, ante-      ...That a female condom has the same length as a male
     appointed lead trainers and peer educators. This chapter                                                                                   natal, PMTCT and post-natal clinics, testing and counseling         condom? People often think the female condom is much
     provides tools for community approaches and describes                   I try to use different methods to reach people. Talking to         sites.                                                              bigger, but this is not the case.
     the engagement with private sector partners (such as                    women at social gatherings works well because there I
     hairdressers) and public sector partners (such as health                meet a lot of different people. Some rich and influential
     clinics) and how their capacities may be built to educate               women also buy from me. They don’t want to buy them in
     and demonstrate female condom use.                                      the open so they come to my salon, and while doing their
                                                                             hair, they buy their female condoms. I have even been                                                                               The lead organization28 may select civil society partners to
                                                                             nick-named “Mammi Protectif’’. This has made me so                                                                                  collaborate with, based on certain criteria:
     1. Introduction: Female condom promotion requires                       popular.”                                                                                                                           • Previous experience collaborating with the civil society
     subtlety and sensitivity                                                                                                                                                                                       implementing partner;
     Female condom programming is not finished when you have                 And your husband is ok with the female condom too?                                                                                  • The status and credibility they enjoy within a given
     supplied outlets, public health clinics and Community Based             “He really loves it, because it has solved certain issues                                                                              community;
     Organizations (CBOs) with female condoms and displaying                 like my fear to make love during my unsafe period. At                                                                               • Familiarity with selected geographic locations in terms of
     posters. That is just the beginning. The most important part            times, when my husband complains of not having a                                                                                       language and culture;
     of our work is related to people’s mindsets regarding female            condom, I quickly offer him a female one. By using the                                                                              • Sufficient supporting conditions like office space and
     condom use. Many people are not aware of the existence of the           female condom, we’ve been more happy in our home. In                                                                                   number of staff that are in a position to devote time to your
     female condom as an alternative way of exercising sexual and            fact many women come to thank me for bringing joy into                                                                                 project;
     reproductive rights. Those who do know of the female condom             their homes by introducing the female condom to them.”                                                                              • Experience with community mobilization;
     will not always have a positive view of it. A lot of work needs to                                                                                                                                          • Experience with programming in general.
     be done here.
                                                                          2. Working from within is the way to go                                                                                                What official documents are needed to encourage proper
     How can we make sure we have access to (potential) users of the      In reaching out to people at community level, it is recommended                                                                        collaboration?
     female condom? The essence of female condom programming              to work from within. People who know the communities and                                                                               • Memorandum of Understanding (MoU) clearly describing
     lies in working in the communities. The acceptance and the use       speak the local languages will be more easily accepted and                                                                                roles and responsibilities of the collaborating organizations;
     of the female condom requires much education and counseling,         trusted by the community. They will also be able to create                                                                             • Documentation of agreements throughout the project phase;
     preferably in inter-personal communication. On community             safe environments for (potential) users who have questions                                                                             • Evidence of financial transactions;
     level, you will encounter hesitance, ignorance and taboos            regarding the female condom. You need people on the ground                                                                             • If an MoU is too formal for the relationship at hand, you
     relating to sex, sexuality and the female condom as a female         who are available within the communities to address the                                                                                   may revert to a more informal “partnership document”
     controlled contraceptive method. This particular context asks        questions and concerns of women, men, community leaders                                                                                   that indicates roles, responsibilities and the extent of
     for collaboration with people and organizations at community         and gatekeepers. These people will also have various networks                                                                             commitment where the scope of work and funding does not
     level that are in a position to adequately address these             within the community that may contribute to creating an           Aunty Queen Beauty Salon in Buea, Cameroon, demonstrations on the       require bank transactions.
     challenges. An important part of what we do is working hard to       environment in which female condom use is increasingly            use of the female condom are given
     get these people on board!                                           accepted and, hence, will eventually encourage female condom                                                                           The civil society implementing partners are often best
                                                                          use.                                                                                                                                   equipped to identify intervention sites and select community
                                                                                                                                            2.1 Civil society implementing partners                              educators who may serve in the capacity of lead trainers and
                                                                                                                                            Collaboration with groups that represent or reach out to specific    peer educators. They can also be made responsible for the
                                                                                                                                            groups of people like Community-Based Organizations (CBOs)           training of the lead trainers. It is important to have a lead trainer
                                                                             Did you know...                                                or faith-based organizations may be strategic in reaching            among the implementing partner’s staff members for first-hand
                                                                             ... That peer educators carry out educational
                                                                             talks in pairs?
                                                                                                                                              28   See chapter 2: How to govern your female condom program




28                                                                                                                                                                                                                                                                                       29
     experience on programming issues. Civil society implementing       to creating a supportive environment for female condom                 2.1.B Peer educators
     partners do not only implement communication activities, but       programming and the creation of demand. They may belong to             Education about the female condom requires a safe                                                                    Habeetat Thaniolode, volunteer of the Society for Family
     also carry out community-based distribution. All implementing      organizations that have a wide reach in the communities by way         environment and a delicate approach when communicating                                                               Health
     partners also receive a stock of female condoms that they can      of reproductive health, family planning and HIV interventions          with (potential) users. The target group needs to feel safe and                                                      Educator at the neighborhood health centre
     make a profit from when selling them.                              that they are a part of. They can also be influential individuals in   comfortable so that they will feel free to raise their questions                                                     Lagos, Nigeria, 29 October 2009
                                                                        a local community who support the project. Lead trainers need          and concerns about female condom use. It often helps when
     The lead organization is responsible for the creation of the       thorough Training of Trainers (ToT) on IEC relating to the female      peer educators are known in the community so that they are                                                           “I found out about the female condom through my work
     preconditions that are needed to implement the program:            condom.                                                                not perceived as total strangers. Peer educators who play a role                                                     with midwives. They see the women who get pregnant
     • Timely payment of transportation fees and daily allowances;                                                                             in inter-personal communication (IPC)29 are vital in the female                                                      year after year. I made the midwife in the neighborhood
     • Timely payment of staff salaries;                                Lead trainers are involved in:                                         condom education and counseling.                                                                                     enthusiastic about the female condom. She is now
     • Timely payment of administration fees;                           • Building the capacity of peer educators and private sector                                                                                                                                recommending it to her clients.
     • Support of office running costs;                                    partners like drug store owners and pharmacists;                    After selecting lead trainers and training them (see Capacity
     • Distribution of IEC materials and female condoms;                • Visiting and monitoring the distribution outlets at community        Building below), a plan of action should be made to select                                                           I’ve also seen to it that the neighborhood women’s centre
     • Training and capacity building sessions to civil society            level;                                                              the peer educators. Selection criteria may be based on the                                                           has now programmed the female condom. When women
        implementing staff.                                             • Advocating and working with community leaders and other              following:                                                                                                           return home after a delivery we give them a maternity
                                                                           gatekeepers;                                                        a. Being representative of a certain group in society;                                                               kit, to which we add a female condom. So they can talk to
                                                                        • Product distribution;                                                b. Having credibility and confidence they enjoy in the                                                               their husbands about it. And say: ‘When you now want to
     2.1.A Lead trainers                                                • Facilitating linkages and referrals to outlets and public health         community;                                                                                                       go to bed with me, I won’t have to turn you down because
     Lead trainers are key to the success of our program: they             clinics;                                                            c. Interest and willingness to participate in the program;                                                           I’m not available because of the delivery.’ In this way we
     disseminate their knowledge and experience to peer educators       • Contributing to the development of training and                      d. Nomination by communities/NGOs/CBOs/facilities and work                                                           prevent men from going to other women.
     in the communities. Implementing partners can help out with           communication materials and data management tools.                      places. This usually ensures the nomination of a positive role
     identifying and recruiting them. Our lead trainers function as                                                                                model or suitable person.
     links between the lead organization and the peer educators and     Each lead trainer can support and supervise five to ten peer           e. Having knowledge of and experience in working at the                                                         2.2 Private sector partners:
     sales points. The lead trainers make an important contribution     educators.                                                                 intervention site e.g. local language and culture;
                                                                                                                                               f. The geographical location of the peer educator and their                                                     2.2.A Hairdressers
                                                                                                                                                   proximity to the intervention site;                                                                         Hair salons are part of women’s day-to-day life. Women often
                                                                                                                                               g. Gender: both male and female peer educators are needed;                                                      visit the hair salon once every couple of weeks and they choose
                                                                                                                                               h. Literacy level: they have to be able to use tools designed for                                               the salon based on their acquaintance with the hairdresser and
                                                                                                                                                   data collection.                                                                                            the quality. The environment is safe and the customer stays
                                                                                                                                                                                                                                                               in one spot for at least one hour, often even more. Hence, it is
                                                                                                                                               The peer educators receive promotion materials that they may                                                    the perfect occasion to introduce the customer to the female
                                                                                                                                               use to share information, educate and communicate about the                                                     condom.
                                                                                                                                               female condom. These include posters, T-shirts, gadgets, and
                   Case Study                     Nigeria                                                                                      caps. Targets are set with regard to the number of people they                                                  The hairdresser can benefit from selling female condoms and
                                                                                                                                               need to educate, which geographical areas they need to cover,                                                   educating her customers about the product. They can attract
                                                                                                                                               the quantity of female condoms they should distribute (sales                                                    some additional profit and it may attract new customers to their
                                                                                                                                               and samples), sales figures, and how they can support sustained                                                 salon.
     A well thought-through program to select, train and support        Before starting their work, the selected lead trainers                 use of the female condom. Peer educators may sell the female
     lead trainers has contributed to the success of the female-        participated in an intensive capacity-building program. This           condoms themselves after sensitization meetings, but they
     condom program run by the Society for Family Health (SFH)          program offers the correct information and explains the use of         can also refer people to specific selling points. Peer educators
     in Nigeria. For SFH, the lead trainers are vital in reaching out   the female condom. Other than that, it also provides skills on         are trained to use the IPC flip chart guide, which is a pictorial                                                    Did you know...
     to communities. The selected lead trainers train and support       how to select, train and support peer educators, and how to            portable communication tool bearing female condom messages                                                           ...That peer educators are not paid but only receive
     the peer educators. They are mentors for the peer educators,       advocate to gatekeepers. SFH organized a series of advocacy            based on specific behavioral determinants.                                                                           travelling expenses?
     and are the contact points for communities in explaining the       visits to gate keepers with the lead trainers in order to gain
     importance of the female condom program. The lead trainers         support for the program and the product and to build the               Peer educators work on a voluntary basis. That is why it is
     bring SFH closer to the communities.                               capacity of lead trainers as advocates.                                important to offer them incentives, such as allowances for
                                                                                                                                               transportation costs and meals. Another way of encouraging                                                      For the success of our program implementation, working with
     In selecting the lead trainers, SFH talked to various community-   SFH meaningfully involves the lead trainers and uses their             the peer educators is to sell the female condoms to them at                                                     hairdressers is an advantage as users can be more easily
     based groups such as civil society organizations, women,           experiences and knowledge in the monitoring and evaluation             a price that will enable them to resell for a small profit. Peer                                                tracked. When returning to the salon after her first try, the
     men and youth groups, and those involved in HIV work-place         of the program. They are invited to review meetings and staff          educators need the continuous support of lead trainers and                                                      customer can tell the hairdresser about her experiences to
     policies and health facilities staff. SFH does not just recruit    retreats, and are given opportunities to address programming           the lead organization in terms of training, review meetings and                                                 which the hairdresser can respond by offering additional
     anyone as a lead trainer; the trainers are selected according      gaps and emerging issues. This ensures not only that there is a        meaningful involvement in the monitoring and evaluation of the                                                  information or encouragement. The hairdresser should report
     to criteria such as interest, motivation and willingness to        feedback system to the program but also that the lead trainers         program.                                                                                                        on the number of regular users in monthly reports to the lead
     participate in the program. Recommendations from government        feel they can contribute and are committed in this way to the
     bodies and networks as well as their track record in the related   program.
     fields or target groups are also taken into account.                                                                                        29   For a more in-depth description of Inter-Personal Communication (IPC), please refer to chapter 4: How to communicate with potential users.




30                                                                                                                                                                                                                                                                                                                                31
     organization. In terms of our program evaluation, these reports                                                                                                                                                                                        to communities, directly with peer educators, or both. Civil
     of sustained use are interesting and valuable as they will expose                                                                                                                                                                                      society implementing partners, that are often community-based
     how we are doing, what strategies work well and which do not                                                                                  Did you know...                                                                                          organizations, have close connections with communities and its
     in a given context, etc.                                                                                                                      ...That for married women the most acceptable way to                                                     gatekeepers and, therefore, have easy access to target groups
                                                                                                                                                   introduce the female condom is to introduce it as a FP                                                   to create acceptability of the product. However, the lead agency
     Some of the benefits of working with hair saloons:                                                                                            method?                                                                                                  may also decide to work with regional staff that works directly
     • Hairdressers are commercially minded and good at selling                                                                                                                                                                                             with the peer educators and other stakeholders (private/
       the product;                                                                                                                                                                                                                                         public). The following case illustrates this.
     • They are known and trusted among the women who visit the
       salon;                                                                                                                                   3. Capacity building
     • It is easier to follow up on the user;                                                                                                   The selected stakeholders involved in the project, such as
     • Hairdressers are visited on a regular basis and each hair                                                                                civil society implementing partners, lead trainers, and peer                                                     Habeetat Thaniolode, volunteer of the Society for Family
       dressing session takes enough time to adequately elaborate                                                                               educators, need constant support in building their capacity to                                                   Health
       on the product.                                                                                                                          implement the project. Some of the areas in which stakeholders                                                   Educator at the neighborhood health centre
                                                                                                                                                require support are:                                                                                             Lagos, Nigeria, 29 October 2009

                                                                                                                                                • Providing accurate information about the product and its                                                       “Today I’ll be educating people about the female condom
        Did you know...                                                                                                                           use;                                                                                                           at many locations in the neighborhood. I visit churches,
        ...Just as is the case with the male condom, women                                                                                      • Countering myths about the product;                                                                            hospitals and traditional bed assistants (traditional
        and men are not always satisfied after using the                                                                                        • Being able to explain the advantages of using the female                                                       midwives). Today I’ll be in the church. I go to places
        female condom for the first time. A peer educator                                                                                         condom and discuss the concerns;                                                                               where there is a need for education.
        needs to follow up to help address and overcome the                                                                                     • Demonstrating the insertion and removal of the female
        challenges and to encourage practice.                                                                                                     condom using pelvic models or hands;                                                                           The women in the church are very interested. They listen.
                                                                                                                                                • Using communication and promotion materials;                                                                   The midwife sent them to this meeting. They are having
                                                                         At the Noble Pharmacy in Bamenda, Cameroon: attendant selling female   • Advocating and working with gatekeepers;                                                                       more and more children, which is dangerous for their
                                                                         condoms                                                                • Learning about selling techniques or referral techniques;                                                      health. I explain to them what they could do about that. I
                                                                                                                                                • Integrating the female condom into other activities and                                                        tell them it protects them against diseases, against STDs,
                                                                         The pharmacist and drug store owner need capacity building               programs, e.g. incorporating female condom programming in                                                      and that it helps in family planning.
                                                                         and training in demonstrating the use of the female condom as            family planning counseling programs, or in HIV-prevention
        Elvis Oviasuyi, pharmacist                                       well as addressing frequently asked questions by customers.              programs.                                                                                                      Nigeria is a poor country. Life here is hard. Everything is
        Benin City, Nigeria, 2 November 2009                             The pharmacies and drug store owners are supplied with                                                                                                                                  very difficult. People have no money. You shouldn’t have
        “In February this year I was invited to a demonstration          promotional materials like posters and leaflets to attract             These issues can be covered by a training session that is                                                        more children than you can afford. What are you going to
        of the female condom. I was amazed. I had never seen             (potential) buyers. The peer educators at community level              especially designed for the lead trainers, who then go on to                                                     do when they’re all at school? We have a song about that.
        something like that. At first I was skeptical, thinking          may then refer female condom users to the drug stores and              train the peer educators and disseminate knowledge and skills                                                    Family planning, what it’s all about; it makes everybody
        that it wouldn’t work. I was afraid that it wouldn’t fit         pharmacies, where the female condoms are sold.                         to them. A Training of Trainers session, female demonstration                                                    better. Shall I sing it?
        right, and that it would easily slide up a woman. They                                                                                  models as well as a manual are all tools to ensure that messages
        convinced me that it does no harm and cannot disappear                                                                                  and skills are disseminated correctly.                                                                           Things are getting better
        up a woman’s vagina.”                                            2.3 Stakeholders in the public sector                                                                                                                                                   Things are getting better
                                                                         If the program’s focus is on social marketing, your main               The lead trainers and peer educators play an important role                                                      As we plan our family
                                                                         interest will not be in building the capacity of the public sector.    in reflecting on the materials and information provided.                                                         Daddy getting richer
     2.2.B Other private sector partners                                 However, even if the program is not focused on distributing            Their feedback is essential in the development of the correct                                                    Mummy getting younger
     Pharmacies, drug stores, supermarkets, roadside kiosks,             through the public sector, you will still need the help of doctors,    information and tools to promote the female condom. Their                                                        Children getting healthier”
     hotels and other private sector partners may be engaged in          nurses, midwives and other public health staff. Hence, you             experiences are valuable throughout the implementation of the
     selling the female condom. They represent the places which          may need to support them. For example: in many societies, the          project. Regular meetings with lead trainers and peer educators
     (potential) users frequently visit. Staff at these outlets needs    doctor and the nurse are well respected, so if they promote the        keeps them motivated, and also helps to review their work in
     training, promotional materials and a constant supply of female     female condom, people may be more likely to try the product.           IPC and female condom demonstrations. 30                                                                         Did you know...
     condoms. These private sector partners play an important role                                                                                                                                                                                               ...That in Mozambique, Community Based
     in providing consistent access to the female condom. They are       Health providers may be hesitant to suggest the female condom                                                                                                                           Organizations are involved in sensitizing their
     less involved in community mobilization and inter-personal          to clients. This may be caused by several things: the supply of        4. Reaching out to the community: added value of                                                                 communities regarding family planning and the female
     communication as their primary duty is to sell products or          the product may be inconsistent, they do not have the necessary        implementing partners and peer educators                                                                         condom? This provides a more efficient way of working
     services for a profit. Therefore, they are of service mainly for    information and tools to educate clients, or they are not              Depending on the context in which you are implementing your                                                      and ensures that the information is passed on by
     regular female condom users who are already familiar with the       convinced of the added value of the female condom themselves.          program, it should be decided whether the lead organization                                                      someone who is familiar with the community.
     product and its use.                                                You may address these obstacles by sensitizing and training            works with civil society implementing partners to reach out
                                                                         the health care providers, providing educational materials like
                                                                         flyers and a manual, and incorporating public health channels
                                                                         in the supply chain management.                                          30   How lead trainers and peer educators can be meaningfully engaged is explained in chapter 2: How to govern your female condom program.




32                                                                                                                                                                                                                                                                                                                             33
                  Case Study                     Zimbabwe


     In Zimbabwe a technical support group chaired by the Ministry       Peer educators: hair dressers, support groups for People
     coordinates and monitors condom programming in the country.         Living with HIV and sex worker groups
     Civil society implementing partners are part of the governance      The peer educators connected to the hair dressing salons,         Tips & Tricks                                                     5. Invest in teambuilding, continuous capacity building
     and implementation structure under the leadership of the            support groups for People Living with HIV and sex worker                                                                               linked to continuous provision of female condoms and
     Ministry of Health and Child Welfare. A total market approach is    groups promote correct and consistent use of the female           1. Involving and training local community-based                      of promotion material: To keep CBOs and peer educators
     used whereby the Zimbabwe National Family Planning Council          condom and also sell the condoms to their clients and peers.         organizations: CBOs have specific knowledge from within           interested and motivated, it is important to invest time and
     distributes the female condom for free, whilst PSI Zimbabwe         The peer educators are from different salons and groups and          their communities, contexts and networks. It is important to      funding in the activities mentioned above.
     socially markets the product. This implies selling the female       the courses serve as a platform to share ideas on condom             build interest, motivate, and acknowledge them.                6. Develop clear capacity building tools: It is helpful to
     condom for a subsidized price. The private sector sells other       promotion with their peers and clients. The peer educators are    2. Working with networks at community level: Community-              convey accurate and consistent messages and address key
     brands to those customers who can afford it.                        certificated and equipped with branded T-shirts and posters.         based organizations know the communities and speak the            issues in promoting the female condom in communities.
                                                                                                                                              local languages, they know the issues and are generally           A Training-of-Trainers manual will help to counter the
     PSI Zimbabwe staff engage in interpersonal communication            Private sector: road shows                                           accepted. Community structures already exist and are easy         challenge of high staff turn-overs in CBOs and among peer
     themselves collaborating with civil society organizations, faith-   PSI Zimbabwe also engages a private sector company which             to use for different issues.                                      educators. Customized IPC cards can sustain motivation
     based organizations, and sexually active youth. Furthermore,        conducts road shows nationwide. Together with locally-based       3. Identify, train, motivate and involve peer educators:             because they standardize messages and reduce time spent
     in reaching out to the communities, PSI Zimbabwe directly           CBOs they conduct one to one and small group discussions.            Peer educators are always part of the community, which            on a session.
     employs regional officers. These officers sell condoms,             The company is contracted to reach a target number of people.        makes them accepted by the community. Think about              7. Availability of female condoms and promotion
     participate in interpersonal communication and supervise care       They are expected to do a minimum of six shows per week. To          incentives for them in terms of profit, personal development      materials: When reaching out to the communities, it is
     promoters, peer educators and private-sector partners.              increase reach and coverage of the female condom, messages           and allowances. Peer educators should keep track of               important to ensure that there are sufficient samples,
                                                                         are integrated with other messages such as those relating to         sustained use.                                                    female condoms for sale, and promotion materials. All
     Care promoters                                                      male circumcision and concurrent sexual partnerships.             4. Link up with mass media campaigns: These can support              should be available to avoid disappointment of the target
     Care promoters receive a training of trainers by PSI Zimbabwe                                                                            the work of the CBOs. After mass education the CBO may            group. Lead trainers, CBOs and peer educators need to be
     staff. Care promoters sell condoms in the communities. They         Distribution                                                         follow up with Inter-Personal Communications sessions.            well equipped at all times.
     then recruit and conduct training of hairdressers, sex worker       More than 50% of the care female condom is distributed through                                                                      8. Plan for short interactive training sessions focusing on
     queens and People Living with HIV support groups as peer            the hair salons. The remaining 50% is distributed through the                                                                          condom use skill acquisition and selling skills.
     educators. In these trainings the peer educators gain skills        sex worker groups, the PLHIV groups, pharmacies and private
     in interpersonal communication and how to demonstrate               health institutions. Monitoring is done through allocated sales
     the correct use and discuss the benefits of using the female        targets, sales documentation, quarterly stock takes and peer
     condom. Care promoters regularly follow up on-job training          education monitoring tools.
     of peer educators. The care promoters are paid a monthly
     allowance and transportation costs.

                                                                                                                                             Did you know...                                                 Challenges
                                                                                                                                             ...That fortnightly mass awareness campaigns are
                                                                                                                                             organized with peer educators of CBOs to sensitize              Promotion and sales
                                                                                                                                             people on the subject of the female condom and                  CBOs are generally good at selling ideas and the creation of
                                                                                                                                             to set up sales outlets within the framework of an              demand. However, they may face serious difficulties when
                                                                                                                                             activity known as “tir groupe”?                                 having to sell an actual product as most CBOs are used to giving
        Fongeh Peters                                                       are married I talk about birth control, or that you can                                                                          out products for free. Addressing the advantages of social
        Team Leader, Etchu Peer Educators Team Buea                         use it when your wife is having her period. I give them a                                                                        marketing, and creating incentives like profit sharing may
        Buea, Cameroon, 3 November 2010                                     demonstration. I show them how to use it. I give them the        Did you know...                                                 counter these difficulties.
                                                                            price and I direct them to the shops where they can buy          That post-menopausal women experiencing poor
        Why did you choose to promote the female condom?                    it.”                                                             vaginal lubrication continue to have healthy sexual             Geographical locations
        “Because of the gender balance it brings. We already had                                                                             lives when using the female condom?                             Selecting, training and supporting lead trainers and peer
        a male condom, now we also have a female condom. It                 You talk to individuals and to groups — what method works                                                                        educators in different regions may be a challenge in terms
        gives women a choice. You can choose which one to use.              best?                                                                                                                            of travel and costs. This may be countered by taking this into
        Since men are dominant in this society I want women to              “Actually both methods work. We try to find people that                                                                          account when budgeting, as well as selecting lead trainers from
        have something that is their own.”                                  are leaders of associations, different organizations,                                                                            various areas who will not have to travel while working with
                                                                            communities or women groups. They invite us to visit                                                                             peer educators in their area.
        What kind of people are interested?                                 them. The best is mixed groups, men and women together.
        “We talk about the female condom to men, women,                     Then they see the advantages together. If you talk to
        parents, all different types of people. I tell them about           women only they still have to bring the female condom
        the advantages of the female condom. For example, that              home and convince their husbands or partners. Given our
        it brings dual protection against STI’s including HIV/              social and religious background this can be a barrier.”
        AIDS as well as unwanted pregnancies. For those who




34                                                                                                                                                                                                                                                                              35
     Chapter 4. How to communicate with potential users
     We want as many women and men to try the female condom                                                                                                                                                 risk groups, and ethnicity (for language and cultural purposes)                                                3.1 Rebranding: Is it worthwhile?
     for themselves. Your communication strategies are essential                                                           Kehinde Mabel Ogunleye, master trainer of SFH                                    are to be considered. For each target audience, a specific                                                     Prior to deciding on rebranding your female condom, you need
     in achieving this goal. Many factors contribute to increasing                                                         Benin City, Nigeria, 2 November 2009                                             promotional strategy should be developed.                                                                      to make sure that rebranding is absolutely necessary in order
     interest for the female condom, but the most essential one                                                            “I provide education on the female condom and train                                                                                                                                             to promote it successfully. Rebranding involves great cost,
     is accurate and persuasive communication toward potential                                                             educators. I know that it’s difficult to convince people.                                                                                                                                       time and energy and should therefore only be considered if
     users. The media may play a pivotal role in this and is in a                                                          They say: ‘What is this, what’s in it for me?’ I then say:                                                                                                                                      you have significant reasons to believe that rebranding will
     position to make your work a lot easier, if collaboration is                                                          ‘It is not poison; just try it.’ But what you don’t know                            Did you know...                                                                                             fundamentally impact your programming. The added value
     established in the right way. This chapter focuses on how                                                             and have never seen before, you don’t try so easily.                                ...That one of the hurdles for the promotion of                                                             of rebranding your female condom should be thoroughly
     to select your target audience(s) and the messages that                                                               But I continue. Not only for the adults, but also for the                           the female condom is that women are often not                                                               investigated by way of market research. You may contract
     you communicate to them. Rebranding the female condom                                                                 children. They must know how to protect themselves                                  familiar with their own anatomy and thus do not                                                             a market research agency to conduct a survey for you that
     may prove to be an effective method to attract potential                                                              from diseases.                                                                      feel comfortable inserting the female condom?                                                               will determine the image that the product should portray to
     users. The different target audiences may be reached by                                                                                                                                                   Messages need to be geared towards overcoming                                                               the public. This needs to be pre-tested among your target
     using a range of different communication strategies, such as                                                          Of course, not everybody is happy with the female                                   this unfamiliarity.                                                                                         audience(s) prior to selecting a brand name and image to make
     sensitization meetings, inter-personal communication by a                                                             condom. Men say: ‘I don’t want that; it’s not real.’ I teach                                                                                                                                    sure that it does actually resonate. Alternatively, it may be the
     peer educator, road shows, and handing out leaflets.                                                                  our educators to ask them: ‘How are you going to provide                                                                                                                                        case that there is an existing brand in your country already
                                                                                                                           for your children? How are you going to pay their school?’                                                                                                                                      which can also be applied to the female condoms that you are
                                                                                                                           We build awareness with men and women. I recently                                3. Branding and rebranding the female condom                                                                   introducing to the market.
     1. Introduction : a carefully developed communication                                                                 talked with a group of older women. For them it isn’t                            Branding is a powerful tool that will help people to relate to
     strategy is the key                                                                                                   about family planning. So I tell them: ‘Take home this                           a product and to believe in its use. Effective branding greatly
     Your target audience(s) should be made aware of the existence                                                         story, preach this gospel to your children. Make them                            influences people’s perception of and interest in the product,
     of the female condom as a contraceptive method, the benefits                                                          aware’.”                                                                         meaning that it is supported by an attractive name, package and
     it may have for them, and how to use it. All of this requires                                                                                                                                          campaign. Branding is a way to encourage people to talk about a
     thorough communication strategies. Your communication                                                                                                                                                  (branded) product. When being told about the female condom,
     towards the (potential) user is supported by accurate and                                                        2. How to determine your target audience(s)                                           people tend to be naturally curious about it. The female condom
     consistent messages as well as promotional tools and materials.                                                  The female condom is a tool that can benefit anyone that is                           will be more appealing to them when it has been packaged
     Your communication strategies31 should be described in your                                                      sexually active. It is important to note that both men and women                      attractively. However, it is not merely the packaging that will
     communication plan32. This plan is based on research on your                                                     need to be targeted and reached with female condom messages,                          determine a person’s perception of and interest in the female
     target audience(s), what kinds of messages will resonate with                                                    and both need to gain access to the product. However, when                            condom: the overall branding of the product needs to be
     them, and what tools will result in the greatest impact. This is                                                 designing your program, it makes sense to target certain groups                       appealing. This may include a branding campaign that makes
     highly context-specific: one generic formula for success does                                                    of people specifically: if you try to reach all at once, you run the                  use of bill boards, radio shows and posters in order to spread
     not exist. Nonetheless, some factors for success may in fact                                                     risk of putting out a message is so that general that it reaches                      the message on the benefits of female condom use. Street
     be generalized: your messages should be accurate, concise,                                                       no one. All of your intervention strategies therefore should be                       marketing may be another useful option to promote your brand
     consistent, and adapted to the specific target audience at all                                                   focusing on a specific target group. This will maximize your                          and get exposure. 34
     times. Your messages should be supported by attractive tools.                                                    impact. Instead of attempting to reach out to everyone at once,
     A brand makes the product more appealing and desired, hence,                                                     individual people tend to feel more directly addressed.                               When manufactured in their respective factories, each female
     a brand campaign increases the success of your promotional                                                                                                                                             condom type is produced according to a generic brand. In
     sessions and sales. And last but not least, media plays an                                                       The selection of your target group depends heavily on the                             some countries, this generic brand is used to successfully
     essential role in generating positive attitudes with regard                                                      outcome of your situational analysis, which relates to the                            raise awareness of female condom use. In other countries,
     to female condom use. That’s why it is important to develop                                                      situation regarding sexual and reproductive health, HIV/                              rebranding the female condom may be needed for it to connect
     your communication strategies in collaboration with as many                                                      Aids and STIs in a given context or country. Whichever target                         to the specific target audience(s) so as to ensure that it will
     stakeholders and potential users as possible as it will allow you                                                audience you choose, your choice needs to be based on                                 receive sufficient attention.
     to fine-tune your communication about the female condom and                                                      evidence-based research. At the same time, it is important to be
     maximize its effectiveness.                                                                                      aware of possible stigmatization of your target group for being                       Two types of rebranding scenarios may be applicable. In the
                                                                                                                      known to use the female condom. 33                                                    first one, you procure the pre-branded female condoms from
                                                                                                                                                                                                            the manufacturer and, upon arrival in your country, you add
                                                                                                                      Promotional strategies come in different shapes and                                   an additional rebranded package to make the product more
                                                                                                                      forms: different target audiences are attracted by different                          attractive in the specific context in which you are working. In
        Did you know...                                                                                               communication channels and messages. It is therefore                                  the second scenario, you design a rebranding for your female                                                   Poster for the Care Campaign, promoting female condoms in Zimbabwe
        ... That the female condom offers a choice for HIV                                                            recommended to map your different target audiences based on                           condom and negotiate with the manufacturer such that your
        discordant couples?                                                                                           their specific needs, which may be related to family planning                         female condoms are packaged according to your rebrand at the
                                                                                                                      and/or STI or HIV/Aids prevention. Not only gender aspects are                        manufacturing site. This means your very own unique branded
                                                                                                                      to be taken into account, also age, geographical location, high-                      female condoms will arrive as such in your country straight from
                                                                                                                                                                                                            the factory.

       31   Refer to Bibliography and Further Reading for more information about communication strategies.
       32   Your communication plan may be part of your marketing plan. Alternatively, it may also be a separate plan in itself. Please see Annex 3 for a simple example of a communication plan outline.     34   Street marketing may involve brand promoters working on the streets to promote the brand. They should be trained regarding passing short messages concerning benefits, negotiation of its use and correct
       33   In some female condom programs in the past, women using or carrying a female condom were labelled “prostitutes” and were increasingly negatively perceived.                                            use, after which they distribute free samples. They may work via an incentives scheme, or receive a monthly stipend, and should wear clearly identifiable outfits to increase visibility.




36                                                                                                                                                                                                                                                                                                                                                                                                                             37
     3.2 Branding campaigns                                                                                     messages to each of your target audiences at all times. In a          4.1 Examples of messages37                                                                                  men feel more free during sexual intercourse, as it is not tight
     Communication and branding campaigns should run in parallel                                                multilingual country, the use of different languages needs to         The information below is based on the FC2, which is the                                                     around their penis like the male condom is. Another advantage
     to encourage curiosity and spark people’s willingness to                                                   be decided on. Each message should clearly communicate the            most common female condom at the moment. Other types                                                        is in the fact that the FC2 may be inserted into the vagina
     learn more about the female condom and to eventually buy                                                   benefits of using the female condom as a dual protection tool,        of female condoms require different messages and overall                                                    before intercourse, meaning that the sex will not have to be
     it. Media and communication campaigns should be launched                                                   with additional emphasis on its use as a family planning tool. 36     communication strategies based on their unique characteristics.                                             interrupted. As the FC2 also conducts heat, having sex feels
     no earlier than the moment at which your peer educators                                                                                                                          More detailed information, both on the FC2 and other female                                                 more natural. 38
     and brand promoters are ready to get started and your sales                                                To increase coverage and to widen the reach of female condom          condoms, can be found in the Frequently Asked Questions
     points are stocked and ready to educate and sell. Community                                                messages, your messages may be integrated into other                  (FAQ) session.                                                                                              How to insert the female condom: Before opening the
     outreach activities compliment mass media campaigns and help                                               sensitization programs e.g. programs on male condoms, medical                                                                                                                     package, you should check the expiry date. If the female
     normalize the female condom, minimize stigmatization, and                                                  male circumcision, concurrent sexual partnerships, sexual and                                                                                                                     condom has not been expired, gently rub the package so that
     generate partner support for the product.                                                                  reproductive health, and family planning.                                                                                                                                         the lubricant is spread equally. Then you may tear the package
                                                                                                                                                                                                                                                                                                  carefully with clean hands. Remove the female condom from the
     Branding campaigns also create visibility. The target audience                                                                                                                                                                                                                               package. Place the inner ring between your thumb and index
     can be asked whether they have come across a bill board or a                                                                                                                                                                                                                                 finger and squeeze it like the number ‘8’. Put the inner ring
     poster of the female condom brand. It should also be noted,                                                   Be aware that, in many countries, the male condom has been                                                                                                                     inside the vagina. When inserted successfully, the inner ring is
     however, that introducing a new product or brand effectively                                                  stigmatized due to the fact that is has often been positioned as                                                                                                               kept in place against the uterus while the outer ring is covering
     takes a significant amount of time. It can take up to a couple of                                             an HIV/Aids prevention tool. Keep this in mind in all decision                                                                                                                 the labia. As is the case with other contraceptive methods,
     years before the brand is actually widely known. Initially, TV                                                making regarding female condom positioning. In many countries,                                                                                                                 insertion of the female condom needs practice. It is advised
     commercials and/or radio commercials introducing the brand                                                    positioning the female condom as a family planning tool has                                                                                                                    to practice inserting it before the actual sexual intercourse
     may help to generate brand awareness. 35                                                                      facilitated product acceptance and use.                                                                                                                                        takes place. Do not be discouraged when you do not succeed in
                                                                                                                                                                                                                                                                                                  inserting it the first time. With some practice, this will improve
                                                                                                                                                                                                                                                                                                  over time.

        Did you know...                                                                                                                                                                                                                                                                           How to remove the female condom: After having sex, you may
        ...Many women express surprise at the size of the                                                          Gideon Taka, Station Manager, Radio Hot Cacoa                                                                                                                                  easily remove the female condom from the vagina by pulling
        condom on first seeing it but accept the product after                                                     Bamenda, Cameroon, 3 November 2010                                                                                                                                             it out carefully. Once outside the vagina, turn it so that the
        being taught about basic female genital anatomy and                                                        “Young people love music. So in the course of playing                                                                                                                          sperm will not come out. Dispose of it where others, especially
        how to use the female condom?                                                                              a good song, the animator can give some hints about                                                                                                                            children, do not have access to it.
                                                                                                                   the female condom. Our animators also attend music                 Poster for the Protectiv campaign: female condom programming in
                                                                                                                   festivals where they show samples of the female condom             Cameroon                                                                                                    Sexual pleasure: Apart from offering you protection against
                                                                                                                   to young people. But we haven’t specifically invited                                                                                                                           unintended pregnancy, STIs and HIV/Aids infection, the female
                                                                                                                   someone to come and talk about the female condom on                About the female condom: The female condom is the only                                                      condom also contributes to the sexual pleasure of both you
     4. Messages                                                                                                   the air. We just talk about it spontaneously.”                     women-controlled contraceptive method that is currently                                                     and your partner. When using the female condom, the couple is
     Whoever communicates to women and men about the female                                                                                                                           available. It offers dual protection: (1) against unintended                                                less concerned with the negative effects that sex may have and
     condom--whether it is the nurse, doctor, pharmacist, journalist,                                              Do you think the media has an important role to play in            pregnancy, and (2) against HIV/Aids and other sexually                                                      may focus on the nice aspects of it. Some men say that the inner
     hotel owner, CBO, barbers, hairdresser, or other type of peer                                                 promoting the female condom?                                       transmitted infections. The main difference of the female                                                   ring is an extra stimulant for the glands. Some women enjoy the
     educator--messages about the female condom should always be                                                   “The media is the most important medium for reaching               condom as compared to the male condom is that the female                                                    outer ring as it may stimulate the clitoris.
     accurate, comprehensive and consistent. Peer educators need to                                                young people. We have specific programmes targeting                condom is inserted into the woman’s body. Hence, it looks
     be comfortable and able to talk about sex, sexuality, pregnancy,                                              young people and they listen to them passionately. There           different as it needs to fit the woman’s body in order to offer                                             Women and men may raise many questions regarding female
     the human body and its private parts, HIV/Aids and other                                                      is always live feedback when they call in from far and             ultimate protection. The FC2 has an inner ring and an outer ring.                                           condom use and how to negotiate it with their partners. Peer
     sexually transmitted infections, safe sex negotiation, and sexual                                             wide. You know, people are always interested in their              The inner ring is inserted into the vagina and placed against the                                           educators, public health staff and outlet personnel need to be
     pleasure. Additionally, each peer educator should be capable                                                  sexuality. Having interactive programmes to promote the            uterus. The outer ring stays outside the vagina. The condom’s                                               prepared! In the annex you will find a list of Frequently Asked
     of countering existing myths regarding the female condom. And                                                 female condom is more effective than just broadcasting             material is soft and comfortable. It is just as safe as the male                                            Questions (FAQs) and suggestions with regard to how you may
     many exist! For example: people may think that using the female                                               adverts. ACMS does a programme with us every Thursday              condom and provides you with an additional contraceptive                                                    answer them.
     condom is uncomfortable. People may also question the level                                                   between 7-8 p.m. called 1OO% Jeune Life, where we                  choice. It depends on the couple whether the female condom
     of protection in comparison to other contraceptive methods.                                                   address certain issues like why and how to use the                 will become their preferred method.
     A peer educator has the important task to answer to these and                                                 condom and who has to insert it; this really attracts the
     other concerns that potential users may have with regard to the                                               audience.”                                                         Benefits of the female condom: The female condom offers                                                         Did you know..
     female condom so as to build their confidence in finding their                                                                                                                   women control with regard to using contraception and                                                            ...That mass awareness campaigns are organized for the
     preferred contraceptive method.                                                                                                                                                  protecting themselves and their partners, as they are the ones                                                  personnel of ministries in order to reach those people
                                                                                                                                                                                      putting it in. Men also tend to like it, as they do not have to                                                 generally overlooked by peer educators?
     Messages need to be standardized to some extent in order                                                                                                                         wear a male condom. Using the female condom tends to make
     to make sure to express the same, consistent and accurate

                                                                                                                                                                                        37   The messages below are generic and merely serve as an example of what a peer educator may emphasize about the female condom in his/her conversations with potential users. Messages should always
       35   Brand awareness is a marketing concept that measures consumers’ knowledge of a brand’s existence.                                                                                be adapted to accommodate the target audience and the specific context as much as possible.
       36   See Introduction for the rationale behind the focus on family planning.                                                                                                     38   See Introduction for more benefits of female condom use.




38                                                                                                                                                                                                                                                                                                                                                                                               39
     5. How to communicate about the female condom                                              5.2 Sensitization sessions                                           5.4 Drama performances                                                                                        6. Promotional materials and tools
     There are different ways in which you may communicate                                      Inter-personal communication may be complemented by                  Drama performances allow the audience to watch the different                                                  Attractive promotional tools and materials will help your
     about the female condom to its potential users i.e. through                                group sessions in which a peer educator39 addresses groups           opportunities and challenges that the use of the female condom                                                target audience to visualize and relate to the product. When
     inter-personal communication, sensitization events, edu-                                   of people, e.g. on the market, in hospitals, during workshops,       may present to couples. Drama performances often show                                                         sensitizing about the female condom, it is important that you
     tainment, and by using visuals. Different strategies may be used                           or in meetings. As is the case in inter-personal communication,      dialogues between sexual partners, raising common questions                                                   demonstrate the product. People should be able to see and
     separately but, more often, combinations of communication                                  the peer educator explains the benefits of the female condom         and concerns. After the drama performance, discussions may                                                    even feel the female condom, complemented by a step-by-
     strategies tend to be the most successful.                                                 and demonstrates its insertion into and removal from the             be held in smaller groups to accommodate cultural barriers as                                                 step demonstration of its insertion and removal. The use of a
                                                                                                vagina by using a demonstration model or his/her hands. Group        much as possible and to facilitate shy people so that they can                                                female condom demonstration model is encouraged but, in
                                                                                                sessions may be organized in separate groups that may consist        ask questions, touch and feel the product freely.                                                             the absence of one, you may also demonstrate female condom
     5.1 Inter-personal communication                                                           of same-sex participants or both sexes, all depending on the                                                                                                                       use by using your hands. Promotional sessions may be further
     When educating about the female condom, you need to talk                                   context. This strategy will help to spark people’s interest in the                                                                                                                 supported by flip charts, posters and flyers. You may support
     openly about sex and sexuality. This is often a very sensitive                             product and proves to be an effective method of informing            5.5 Visuals: Leaflets, posters and banners                                                                    your peer educators by offering them discussion guides and
     endeavor, for both the educator and his or her audience. It                                larger groups of people at the same time. The disadvantage of        Posters, banners, leaflets, websites and other written and                                                    FAQ cards.
     is important that the audience / potential user feels safe,                                this approach lies in the fact that the environment often does       visual material provides you with a way of communicating
     respected, and taken seriously. A good way of ensuring this                                not allow for very personal questions or concerns to be voiced       towards your target audience(s). Messages should be the same
     is by inter-personal communication (IPC). IPC is a face-to-face                            by the participants. That is why the peer educator, who has          as the ones conveyed through inter-personal communication,                                                    6.1 Developing material40
     method that takes place between the educator and the potential                             been trained in counseling, should always be available after the     sensitization or edutainment, but need to always be concise as                                                When developing promotional material and tools, the following
     user in which there is inter-personal dialogue about the female                            session has ended in order to address personal issues.               people often are not focused enough to read large texts. Visuals                                              steps may be followed:
     condom and room for the user to voice concerns and ask                                                                                                          should be made as appealing as possible by using bright colors                                                1. Focus group discussion: What kind of promotional materials
     questions.                                                                                                                                                      and photos. After the promotional session, people may take a                                                      resonate with the target group? This depends on their level
                                                                                                5.3 Edu-tainment: Road shows and drama performances                  leaflet home to show it to his or her partner. They may also visit                                                of knowledge, literacy and language use.
     There are many questions a person may not dare to ask                                      Another method used to raise awareness about the female              a website for more information. The personal touch to female                                                  2. Budget analysis: What budget is available for the production
     when other people are around. For example, women may                                       condom is by organizing road shows and drama performances.           condom promotion nonetheless is essential to make people feel                                                     of materials?
     be concerned about inserting the female condom into the                                    Road shows are part of a communication strategy that aims to         comfortable enough to open up to the product and its use.                                                     3. Reviewing existing promotional materials and tools: Existing
     vagina. Or men or women may not know how to introduce the                                  entertain as well as convey key messages on female condom                                                                                                                              materials and tools may be adapted to suit the context and
     female condom to his/her partner. These sorts of concerns will                             use. It is efficient as it generally has a much wider reach: one                                                                                                                       environment.
     probably not be raised openly when they can be overheard                                   road show may reach up to 250 people. The audience may                                                                                                                             4. Message and visual development: What should be included
     by others. Therefore, he or she may feel more comfortable                                  be engaged by playing their preferred popular music while                                                                                                                              in the texts? How long should the texts be? What kind of
     when having a one-on-one discussion with a peer educator.                                  they learn about the female condom at the same time. During                                                                                                                            drawings and photos are appropriate and useful to include?
     Furthermore, the potential user may touch and feel the                                     the show, participants are invited to participate in condom                                                                                                                        5. Developing new materials: A graphic designer should be
     female condom and even practice the insertion with help of                                 demonstration competitions and compete to win prizes. Also,                                                                                                                            contracted to design the new materials.
     a demonstration model or his/her hands. The peer educator                                  they may be invited to answer questions regarding female                                                                                                                           6. Pre-testing: A focus group discussion with the target
     thus plays an important role in creating a safe space and must                             condom use. It is important to note that the shy types may                                                                                                                             audience will help to identify the usefulness of the tools and
     be comfortable talking about sex and sexuality. Although inter-                            not benefit as much from road shows. To engage them, the                                                                                                                               materials. Furthermore, pre-tests need to determine whether
     personal communication is very effective in conveying accurate                             group may be divided up into smaller groups of 25 people to                                                                                                                            the target group actually understands your messages, texts,
     and comprehensive messages about female condom use and                                     help people to feel more comfortable and allow everyone to                                                                                                                             photos and drawings. These pre-tests may be continuous
     addressing personal concerns of the potential user, this method                            touch and feel the female condom as well as practice condom                                                                                                                            throughout the development process.
     also requires much time and effort, and outreach remains                                   demonstration. Role plays of condom use can also be part of                                                                                                                        7. Finalizing the materials: After adaptation and the pre-testing
     limited.                                                                                   the show. Proper planning of the road show is key so that the                                                                                                                          stage, the materials may be produced.
                                                                                                facilitators are aware of the different segments that the show                                                                                                                     8. Distribution: The materials are distributed to the peer
                                                                                                entails e.g. introduction, dancing, role playing, competition,                                                                                                                         educators and other stakeholders and they are trained in
                                                                                                small group discussions.                                                                                                                                                               using them.
        Did you know...
        ...That some women feel safer using the female                                          The discussions that take place at the end of the show are                                                                                                                         What does a peer education take with her/him?
        condom as they claim their partners tear the tips of                                    most important for people to remember your female condom                                                                                                                           • Samples of female condoms for demonstrations
        male condoms to infect or impregnate them?                                              messages. When an implementing organization is ill equipped                                                                                                                        • Female condom demonstration model41
                                                                                                to organize a road show, drama and theater firms may be                                                                                                                            • Female condoms for sale
                                                                                                contracted to organize the shows for them. Shows may run                                                                                                                           • Female condom manual for her/his own referral
                                                                                                daily or once every few weeks. Organizing road shows requires                                                                                                                      • Flip chart with drawings/photos
                                                                                                proper planning and preparation to make sure that it is                                                                                                                            • Female condom uniform: a baseball cap, a t-shirt, jacket, etc.
                                                                                                announced timely and appropriately within a given community.                                                                                                                       • Flyers/leaflets to give out
                                                                                                                                                                     Poster for the Elegance campaign, female condom programming in
                                                                                                                                                                     Nigeria



       39   Refer to Bibliography and Further Reading for more information on peer education.                                                                          40   Refer to Bibliography and Further Reading for tools for developing information and education material.
                                                                                                                                                                       41   In case of absence of a demonstration model, the peer educator needs to be trained to demonstrate the female condom use with his or her hands.




40                                                                                                                                                                                                                                                                                                                                                      41
     7. Involving role models to convey your message                     selected for over time. Keeping this in mind, these models may                                                                         Furthermore, the song can also be played outside Cameroon
     Public figures, such as musicians and other local celebrities,      have to be changed over time to adapt to a changing context.                                                                           because internationally renowned and popular artists have
     may have a very strong influence on their fans and supporters.      Research should be done to determine who could be used                                                                                 been associated with the project. Besides, it does not need any
     When they convey the positive message on the female condom,         as a role model and what messages they could communicate.                                                                              authorization to be played in radios or clubs and people can
     larger groups of people may be reached. It is likely that they      Another important question is related to how they are relaying                                                                         obtain the song and play it over and over again. In this way the
     will develop a positive attitude towards the product because        these key messages, bearing in mind that messages must                                                                                 impact of the message increases.
     their idol promotes it. Popular role models have their own          conform to the key message of the female condom programming
     agendas, hence involving them in the promotion of the female        within the specific national or regional context.                                                                                      As well as this, two promotional and educational TV and radio
     condom needs to benefit them as well. If you engage an artist,                                                                                                                                             advertisements were broadcasted and a poster campaign was
     they can compose a popular song about the female condom.                                                                                                                                                   carried out in the project areas. Flyers were distributed and
     It will increase their popularity and it shows that they are                                                                                                                                               articles were written for the print media.
     committed to the well-being of their fans. Another advantage of        Ede Meyiwa (Mimi), field officer for SFH Lagos,
     a song is that it is a long-term strategy: the song can be played      Nigeria, 29 October 2009                                                                                                            One of the most important contributions this communications
     even months after its launch and people will keep hearing it            “At first people are always sceptical. They ask what I        Manu Dibango is a well-known jazz artist from Cameroon, and the      campaign made is that, besides the fact that people repeat
     once downloaded or bought. Other role models like writers,             want from them, why I visit. I tell them that I’m concerned    leading artist in a music-video clip to promote the female condom    in chorus the campaign slogan “I have things under control”
     cartoonists, athletes or TV icons may also serve as entry points       about their staff; that it’s about caring for people. When                                                                          whenever given the opportunity, it also popularized the female
     to a larger and often younger public.                                  I tell them that, people open up. They ask me to tell them     The song was broadcast on a large scale in various media, since      condom to the public and quickly developed brand awareness
                                                                            more and even ask for condoms, to give to their staff.”        messages from artists have significant influence on the targets.     of ‘Protectiv’.
     However it is pertinent to note that role models are only human                                                                       These leaders within the community were taken for models.
     and they may not hold onto the ideals that they were originally                                                                       In the preliminary phase of the production of the song, Focus        The communications campaign “I have things under control”
                                                                                                                                           Group Discussions were organized to identify role models and         was launched by the Minister of Public Health and the Minister
                                                                                                                                           to learn how they felt about promoting the female condom.            of Women Empowerment and Family. It aimed to encourage
                                                                                                                                           After that the whole production process started, from signing        appropriation of the female condom by the target groups
                                                                                                                                           contracts with artists, managers and production agencies, to         through awareness of its proper use, and involvement of men to
                                                                                                                                           writing the song and video clip, to recording, mixing and editing.   support their partners in adopting this method of contraception.
                                                                                                                                                                                                                These combined actions will lead to the elimination of prejudice
                                                                                                                                           Till today, the song and the video clip have remained in             and stigma in relation to the female condom.
                                                                                                                                           the playlists of radios and TV stations and can always be
                                                                                                                                           programmed later on. Thus, the lifespan is not linked to the         The song can be downloaded
                  Case Study                     Cameroon                                                                                  duration of the project.                                             http://www.youtube.com/watch?v=65kYjCyTedA




     Chapter Media                                                       An important part of the campaign included a popular (but at
                                                                         the same time educational) song on knowledge and correct use
     Case Study: Media Campaign “I have things under control”            of the female condom. This promotional song was recorded
     - Cameroon                                                          by national and international artists and distinguished leaders   8. Media for female condom promotion                                    myths and misconceptions that surround the female condom.
                                                                         including Manu Dibango, Anne Marie Nzié, Narcisse Pryze,          People receive hundreds of messages per day through TV,              3. Rebranding. If you have decided to rebrand your female
     Under the title “Je prends les choses en main” (“I have             Lady Ponce, Isnébo, Prince Afoh Akom, Majoie Ayi, Nono Flavie,    news papers, the Internet, radio and magazines. Media are an            condom, branded mass media campaigns will support the
     things under control”) ACMS developed a comprehensive               Corry des Macases, Valséro, Atango de Manadjama, Kardinal         effective way to send out messages about the female condom              introduction of your unique brand in the market.
     communications campaign to facilitate the acceptance of the         1er, Valery Ndongo, Michèle Ngoumou, Boudor and Fally Ipupa.      and contribute to a positive attitude towards it. However, it is     4. Advocacy. Campaigns and media messages do not only try
     female condom by the people in Cameroon. ACMS worked with           Through this song, all these well-known and respected people      not easy to explain what the female condom is, what its benefits        to convince the end user to use female condoms, they also
     the support of a Communications Consulting Agency.                  sent an important message to a large number of the people of      are, and how to use it by using the type of short and catchy            target decision makers at different levels. Decision makers
                                                                         Cameroon.                                                         sentences that media often use. Therefore you should carefully          get a sense of urgency and importance when they see and
     The campaign showed that the female condom is a device used                                                                           design and monitor the impact of your media messages. When              hear about the female condom through different channels.
     to prevent unplanned pregnancies and STIs including HIV,            Messages developed during the campaign focused on                 planned and executed with care, media has certain advantages:
     not only for all women who know what they want, but also for        various issues, such as myths about comfort, esthetics and
     men who want the best for women. The campaign had three             reliability; ignorance about the female condom and its use; and   1. Recognition and acceptability. When using different
     objectives:                                                         stigmatization of users of the female condom as being reserved       media outlets to convey your message, people will recognize
     1. The development of the brand name ‘Protectiv’,                   to sex workers. To solve this problem, communication themes          your campaign after a while. Seeing and hearing the same             Did you know...
     2. Building the capacity of women to be able to use the female      encompassing all the contours of the problems of the female          message in the public arena will eventually normalize the            ...That many peer educators respond to the complaint
         condom correctly and to use it as a device for family           condom were elaborated by ACMS. Interventions were relevant          product and will contribute to increased acceptability.              that the female condom is a little expensive by saying
         planning,                                                       in the sense that they were presented in the form of advice and   2. Awareness raising about the female condom. Media can                 that having an unintended pregnancy or STI is much
     3. Help men to encourage their partners to use the female           prescriptions from those who are models for the target.              be a strong tool to communicate a positive message about             more expensive?
         condom.                                                                                                                              the product, while at the same time countering the concerns,




42                                                                                                                                                                                                                                                                                 43
     8.1 Media planning                                                   channels. Easily recognizable jingles or music in TV and radio      partnerships with private, public, federal and state media                                   Visibility, consistency and repetition of the female condom
     Media can be a powerful tool to sensitize people about the           campaigns may also increase the popularity of the product.          organizations may get you free air time dedicated to sexual and                              message in the media will contribute to getting the female
     female condom, while at the same time its effects can be             Jingles can additionally be formatted into ringtones.               reproductive health, women’s rights and HIV prevention. These                                condom message to resonate with people. If, at the same time,
     disastrous if expressions in the media contain incorrect and                                                                             partnerships will significantly contribute to the success of the                             people see posters, leaflets, and other promotion materials
     stigmatizing messages. Working with media therefore requires         Before starting your broadcasting campaign, it is recommended       female condom program. Knowing what interests them as media                                  at shops, hairdressers or with peer educators, they are more
     thorough planning. Before starting it makes sense to find out        to look into the need to be granted permission from a regulating    partner will help you to emphasize the mutual partnership. Key                               likely to adopt a positive attitude towards it. Complementarity
     which media and advertising laws exist in your country. In           body. Pending decisions by these bodies may delay the project.      to successful partnerships is inclusion of representatives of the                            of communication channels and strategies is therefore very
     some countries, a law is enforced that orders the prohibition        If possible, it is wise to involve these regulating bodies in the   union of journalists in the program’s supervisory body from the                              important.
     of advertising for medical products. If this is the case in          design of the media campaign to avoid unexpected negative           start of the program.
     your country, you need to find out if the female condom is           responses and even prohibition of launching the campaign.
     considered a medical product in your country, before designing
     and planning your marketing strategy. If so, it is advisable to                                                                          9. Visibility                                                                                   Did you know...
     involve the Ministry of Health to avoid prohibition of female                                                                            There are specific moments throughout the year that offer                                       ...That one of the biggest concerns of women is the fear
     condom advertising.                                                     Women, Promoter of the Mey-Low-D Foundation                      opportunities to raise media attention to female condoms                                        of the female condom slipping into the vagina42?
                                                                             Bamenda, Cameroon, 3 November 2010                               e.g. Women’s Day (8 March), World Contraceptive Day (26
                                                                             “I tell people that what we are trying to promote here is        September), World Aids Day (1 December), or visits of foreigners
                                                                             responsible sex. We want people, irrespective of their           or delegations to the country.
                                                                             religious background, to feel free with their sexuality.
                                                                             We want them to protect themselves and prevent the
                                                                             spread of diseases. We make sure that we have no moral
                                                                             judgement from those who see us as sex promoters. No
                                                                             parent would be happy if their child contracted a disease
                                                                             or carried an unwanted pregnancy; most parents will              10. Advantages and disadvantages of the use of different communication channels
                                                                             be happy to know that their children are able to protect
                                                                             themselves.”
                                                                                                                                               Communication Channel                                         Advantages                                      Disadvantages


                                                                          8.3 Monitoring                                                       Inter-Personal Communication                                  • permits dialogue                              • requires specific training and follow-up
                                                                                                                                                                                                             • creates a safe environment                      support
                                                                          Expressions in the media need continuous monitoring.
                                                                                                                                                                                                             • allows personal issues and concerns to        • reach is limited
     Hot Cocoa Radio Station Bamenda in Cameroon: Radio is an important   Newspapers, radio or television may publish or express
                                                                                                                                                                                                               be raised                                     • difficult to keep messages consistent
     communication channel                                                negative or inaccurate statements regarding female condom                                                                          • allows for a tailor-made response and         • may be expensive
                                                                          use. Fix mistakes by responding with letters or articles in                                                                          education
                                                                          newspapers or on the Internet. By having fact sheets ready,                                                                        • allows for a clear message (no
                                                                          responses can be quick to limit the negative impact of an                                                                            distraction from environment)
        Did you know...                                                   incorrect piece in the media. Proactive press releases should be
        ...That the Armed Forces are involved in the project              sent out on a regular basis.                                         Community level activities:                                   • higher number of people reached at the        • less opportunity for personal questions
        through women soldiers and the wives of the military                                                                                   sensitization meetings, road                                    same time                                       and concerns
        being trained and acting as peer educators?                                                                                            shows, drama, community                                       • may have more credibility because of          • low frequency
                                                                          8.4 Capacity building of media and partnerships                      media                                                           support from community leaders                • low reach as compared to mass media
                                                                          In many countries, especially where female condoms are fairly                                                                      • may allow for participatory approaches        • may be costly, especially when wanting to
                                                                                                                                                                                                             • may be more cost effective due to large         scale up
                                                                          unknown, messages in the media tend to stigmatize the product
                                                                                                                                                                                                               number of people reached at one time
                                                                          and at the same time contain incorrect information. One way to
     8.2 Media channels                                                   give your communication a positive twist and limit the extent
                                                                                                                                               Media: tv, radio, newspapers,                                 • great outreach                                • target audience may not have access
     There are different channels of communication that support           to which negative messages about the female condom are
                                                                                                                                               magazines and internet                                        • many publications on public health to         • needs continuous monitoring
     your message. Conventional channels like (community)                 being expressed is to build the capacity of journalists in their                                                                     tap into                                      • relationship-building with media is time
     radio, television and newspapers are worthwhile to explore.          reporting on the female condom. It is important for expressions                                                                    • reaches out to many different target            consuming
     However, there are more ways of integrating female condoms           in the media to be as consistent and unambiguous as possible.                                                                        groups                                        • your message is not always newsworthy
     into existing media, like having it mentioned in TV interviews,                                                                                                                                         • can use local languages                       • it may be very costly, especially when
     or having it discussed in discussion programs, soap series or        At the same time, media directors can be offered training on                                                                       • news articles have space for                    producing TV spots and buying air time
     movies. It is recommended to get informed on what kind of            the subject. This will help in negotiating media prices. It is                                                                       elaboration and nuance
     media the target group(s) use and in what languages they can         recommended to be informed about the various media laws                                                                            • the Internet reaches young people
     be reached. This should be integrated in the initial research by     that exist in the country to see if there is maneuvering room                                                                      • allows for creativity
     which you determine your communication strategy. Innovative          for negotiating a reduced media price. In many countries it is
     communication channels such as group SMS and social media            very expensive to buy airtime and broadcast a female condom
     (e.g. Facebook, Twitter, YouTube) can be useful to attract your      media campaign. Investing in partnerships with media outlets
     audience and may prove to be very strong communication               can help you to overcome this difficulty. Additionally, building      42   This cannot happen due to the outer ring outside the vagina. See also FAQs.




44                                                                                                                                                                                                                                                                                                           45
     Tips & Tricks
     •	 Your	communication	strategies	should	be	described	and	                                       •	 Properly	equip	your	peer	educators	with	samples	of	the	
        justified in your communication plan43. This plan is based on                                   female condom, a female condom demonstration model,
        research on the target audience, what kind of messages will                                     female condoms for them to sell, a female condom manual
        likely reach them, what tools will have the greatest impact                                     for her/his own referral, a flip chart with drawings/photos, a
        and will bear the best results.                                                                 female condom uniform, and flyers/leaflets to hand out.
     •	 Selecting	your	target	group(s)	is	informed	by	the	situational	                               •	 Find	out	if	rebranding	of	the	female	condom	is	necessary.	If	
        analysis you conducted in your country, emphasizing the                                         so, contract a branding company and make sure to conduct
        situation with regard to sexual and reproductive health, HIV/                                   regular pre-tests with your target audience.
        Aids and STI infection rates.                                                                •	 Consider	the	timing	of	your	communication,	branding	and	
     •	 Make	sure	that	your	peer	educators	are	comfortable	talking	                                     media campaigns. When they run in parallel, people are
        about sex and preferably have used the female condom                                            more likely to recognize your product.
        themselves to be able to discuss their own experience.                                       •	 Engage	popular	celebrities	to	contribute	to	a	video	clip,	
     •	 Invest	in	people	and	places	where	inter-personal	                                               radio or TV commercial, or any other expression in the
        communication is able take place: a hair salon where the                                        media that will give exposure to the female condom.
        female client is educated about the female condom in                                         •	 Conduct	a	study	on	media	usage,	reach	and	languages	used.
        private is a safer space than a crowded bus station.                                         •	 Think	of	attractive	messages	that	you	may	use	to	praise	the	
     •	 At	the	same	time:	identify	places	where	you	will	find	large	                                    female condom in the media and use jingles or music that
        groups of people (like markets and bus stations) for group                                      people will recognize easily.
        sensitization meetings.                                                                      •	 Complement	your	mass	media	campaign	by	conducting	
     •	 Road	shows	may	link	serious	messages	with	entertainment	                                        regional and local promotional activities.
        and attract large groups of people. Make sure that there is                                  •	 Build	the	capacity	of	journalists	and	media	directors	to	
        space for smaller group discussions afterwards to address                                       increase your chances of having them express accurate,
        questions and to make sure people understood your                                               consistent and unambiguous messages about the female
        messages.                                                                                       condom and expanding your exposure in the media.
     •	 During	promotional	sessions	you	should	use	the	support	                                      •	 Include	representatives	of	the	union	of	journalists	in	your	
        of visuals, such as posters and leaflets, and refer people to                                   program’s supervisory body.
        your website for more information.




     Challenges
     •	 People	using	the	female	condom	may	be	stigmatized	in	                                           method only, e.g. it can come to be perceived to be ”cool” to
        society. Hence: consider promoting the female condom as a                                       carry a certain brand of condom with you. Carefully assess
        contraceptive method for all sexually active people and do                                      your specific context, your organizational capacities and
        not only specifically target one or several high-risk groups.                                   available funding when consider whether rebranding is
     •	 After	training	your	peer	educators	it	may	be	the	case	that,	                                    feasible and necessary for more effective female condom
        over time, messages become inconsistent and inaccurate                                          promotion.
        information is being shared. This is only human, as peer                                     •	 Developing,	publishing	and	repeating	your	female	condom	
        educators may forget what they have been taught during                                          media campaign may be very costly and time consuming.
        their training and/or new developments may affect your                                          Invest in the most effective channels of communication
        preferred messages. Therefore, you should visit your peer                                       available to you and budget for it accordingly.
        educators while they are educating people and invite them                                    •	 The	lack	of	knowledge	of	journalists	and	media	directors	
        for regular review meetings to refresh their knowledge.                                         can result in negative messages about the female condom.
     •	 Rebranding	is	a	time	consuming	and	expensive	exercise	that	                                     They need sensitization and guidance in publishing about
        requires the involvement of many stakeholders, including                                        the product and/or related fields.
        the government. Nonetheless, rebranding may also have                                        •	 Government	bodies	or	other	regulating	mechanisms	may	
        major advantages in making the product more appealing                                           delay their approval which in turn delays the airing of mass
        and distancing the user from the product as a contraceptive                                     media campaigns. Beware of this and plan for it in advance!

      43   A communication plan can be part of a marketing plan, but can also be a separated plan.




                                                                                                                                                                         Promotion sticker of Protectiv female condoms at the Sidony Beauty
46                                                                                                                                                                       Salon in Bamenda, Cameroon                                           47
     Chapter 5. Advocacy towards decision makers
     The female condom is often a fairly new and unknown                                                                                                                         enough. Citizens or organizations can and should hold
     contraceptive method in a given society. Moreover, when                                                                                                                     governments to account with regard to their rights to overall                                                       Elvis Oviasuyi, pharmacist
     people do know about the female condom, it tends to be                                                                                                                      good health, sexual and reproductive health in particular, and                                                      Benin City, Nigeria, 2 November 2009
     surrounded by stigma and taboos. Hence, the support of                                                                                                                      access to contraceptives including the female condom.                                                               “We use it because we think it’s fun, but it also comes in
     decision makers is of great influence in the promotion and                                                                                                                                                                                                                                      handy in family planning. We have three children, still
     overall societal approval of the product. Generating an                                                                                                                     It is important to continuously bring female condoms under                                                          young; that’s plenty for us.”
     overall positive attitude towards female condom use and                                                                                                                     the attention of decision makers in government or parliament,
     its benefits needs constant sensitization and engagement                                                                                                                    because government faces many issues in society which will
     of influential societal leaders. This chapter describes                                                                                                                     be competing for attention and funds. Personal and political
     how you may advocate for your cause with different                                                                                                                          interests also determine the level of commitment. Decision                                                     3. Developing an advocacy strategy
     decision makers—such as community leaders and other                                                                                                                         makers need to constantly be reminded of the importance and                                                    Advocacy requires proper planning and a comprehensive
     gatekeepers, government and institutions—so that you                                                                                                                        urgency of investing in female condom programming. They are                                                    strategy. The ten-step process described below will help you
     will generate their support, effectively promote the female                                                                                                                 the ones that can turn the tide: they can exert their influence to                                             to develop an appropriate advocacy strategy to encourage the
     condom with them and, subsequently, secure funding                                                                                                                          bring about positive change.                                                                                   policy or decision making change you need to successfully
     for female condom programming. This will significantly                                                                                                                                                                                                                                     promote female condom use.
     contribute to your ability to create demand and increase
     access to the female condom.                                                                            Demonstrating female condoms to the Minister of Women Empowerment
                                                                                                             and Family in Cameroon.

     1. Introduction: Exerting influence to bring about positive                                             Advocacy is a time consuming and continuous exercise. Within
     change                                                                                                  your operational team, staff should have the competencies and
     The success of the implementation of your female condom                                                 time to engage in advocacy processes. Successful advocacy           The 10 steps of your advocacy process47                                                                        6. Select channels of communication
     program depends to a large extent on how conducive and                                                  requires a very specific skill set and even a certain personality                                                                                                                     Common advocacy channels are position papers, letters,
     supportive the political and social environment is in which                                             type. It is important that your advocacy staff is able to build     1. Define the issue                                                                                               fact sheets, public debates, and conferences targeting policy
     you work. Community leaders44 and other gatekeepers45 as                                                and maintain sustainable relationships. They should be able to         Advocacy begins with identifying the issue or problem that                                                     makers. Your target audience determines the most
     well as the national government need to be actively engaged                                             communicate a convincing message and empathize effectively             requires a policy or decision making change.                                                                   appropriate medium for your advocacy message.
     with your female condom programming to avoid resistance to                                              with the points of view of different stakeholders. If there is no
     the product and to the people who implement your program.                                               institutional capacity to hire an advocacy officer, it should be    2. Set goal and objectives                                                                                     7 Raise funds
     Government in particular should play a role in making                                                   clearly indicated who will take up these activities and dedicate       A goal is a general statement of what you hope to achieve in                                                  Advocacy campaigns always benefit from external funding
     female condom programming sustainable by developing and                                                 (part of) his or her time to it.                                       the long term (three to five years). The advocacy objective                                                   and other resources. Identify possible donors for the
     implementing supportive policies and by allocating necessary                                                                                                                   describes short-term, specific, measurable achievements                                                       campaign.
     funding. Advocacy is a process of both engaging decision                                                                                                                       that contribute to the overall advocacy goal.
     makers, as well as ensuring sustainability by integrating female                                        2. What is advocacy?                                                                                                                                                               8. Develop your implementation plan
     condoms in national policies and programs. When government                                              Advocacy is a process aimed at decision makers or policy            3. Identify your target audience                                                                                  Develop an implementation plan that identifies activities
     officials or other influential leaders or gatekeepers are part                                          actors to bring about a change in policy, budgeting and/or             The desired policy change is facilitated by specific decision                                                  and tasks, responsible persons/committees, the desired time
     of the supervisory body46 of your program, this will positively                                         legislation according to your cause. Female condom advocacy            makers or other influential people. Assess their positions                                                     frame, and required resources.
     influence your overall advocacy objectives as they can promote                                          generally aims to encourage the development of supportive              and relative powerbase and find out whether or not
     your cause with their colleagues, constituencies, and in their                                          government policy that ensures the availability of and access to       they support, oppose, or are neutral to the issue you are
     networks. However, getting them on board is an entire advocacy                                          the female condom for anyone who wants to use it. An advocacy          advocating for.                                                                                             Ongoing activities:
     process in itself.                                                                                      process benefits larger groups of people. Advocacy works
                                                                                                             towards policy change, which is always long-term. This is what      4. Build support                                                                                               Collect data
                                                                                                             distinguishes advocacy from changing opinions and behavior.            Find supporters to strengthen your advocacy message within                                                  Advocacy objectives, advocacy messages, and identifying the
                                                                                                             Advocacy helps to create an environment in which female                NGOs, networks, donors, coalitions, civic groups, journalists,                                              policy and decision makers and your supporters require data
                                                                                                             condom use is supported and able to spread.                            churches, professional associations, women’s groups,                                                        collection. This is an ongoing process.
        Did you know...                                                                                                                                                             activists, and individuals.
        ...That famous artists and personalities are                                                                                                                                                                                                                                            Monitor and evaluate
        committed to promoting the female condom through                                                     2.1 Why is advocacy important?                                      5. Develop your message                                                                                        Monitoring and evaluating the advocacy process is about
        songs?                                                                                               In every society, there are issues that are not adequately             Advocacy messages need to be adjusted according to the                                                      measuring your progress and results. What achievements are
                                                                                                             addressed by government. Often, this holds in particular for           target audience and include the problem statement, facts,                                                   you aiming for? When defining your advocacy objectives, make
                                                                                                             sexual and reproductive health matters as openly discussing            persuasion and the desired action of the policy and decision                                                sure to consider how to measure them.
                                                                                                             them is a taboo, considered complex and/or not important               maker.




       44   Community leaders are local government leaders and religious leaders.
       45   Gatekeepers are opinion leaders like chiefs, traditional rulers, and other influential people.                                                                         47   Based on the 10 Steps in the Advocacy Process of the Policy Project: Networking for Policy Change: An Advocacy Training Manual by POLICY (January, 1999),
       46   See chapter 2: How to govern your female condom program                                                                                                                     http://www.policyproject.com/pubs/AdvocacyManual.cfm




48                                                                                                                                                                                                                                                                                                                                                                 49
     3.1. Defining the issue                                                                                         Specific: The objective has to be clear and say exactly what the                 need to be aware of existing policies, committees, strategies                                                   parliamentarians or parliamentarian groups, national HIV/Aids
     When developing your advocacy strategy, you should                                                              outcome should be;                                                               and programs that involve the government and are influencing                                                    committees, national HIV/Aids technical bodies, or reproductive
     determine a problem or an issue in your environment, region or                                                                                                                                   the playing field for female condom promotion. Some countries                                                   health/family planning technical bodies or working groups.
     country that you expect may be positively influenced by policy.                                                 Measurable: In order to know if you have achieved your                           have condom strategies already that could perfectly fit in
     In the field of female condom promotion, the problem is likely                                                  objective, it is best to have quantitative goals, e.g. indicating by             female condom promotion. Most countries have a national                                                         In order to target the policy makers who are in a position to
     to be related to sexual and reproductive health and HIV/Aids.                                                   how much funding should be increased;                                            reproductive health or HIV/Aids policy. This data collection                                                    contribute to positively influencing the position of the female
     Examples of the advocacy issue could be:                                                                                                                                                         should be done as a baseline study: you will need to assess                                                     condom in your country, it is helpful to identify and analyze
                                                                                                                     Achievable: The objective has to be ambitious, but not overly                    and document the current situation so that, when you evaluate                                                   them on the basis of certain criteria.
     • In country X, there are [number] unintended pregnancies due                                                   ambitious so that it is impossible to reach. It has to motivate                  the impact of your advocacy strategy, you will know if you
       to a lack of access to contraceptives;                                                                        people to do their best and know that they can achieve the                       have had any impact. It needs to be noted however that budget                                                   For example:
     • In our country, women and men do not have access to                                                           stated goal;                                                                     analysis is extremely difficult as many governments are not very                                                1. The status they enjoy nationally;
       contraceptives;                                                                                                                                                                                transparent in publishing these figures.                                                                        2. Their political influence;
     • In our province, many girls are getting pregnant because they                                                 Realistic/Relevant: The objective has to aim towards achieving a                                                                                                                                 3. Objectives that they aim to achieve in their personal and/or
       lack knowledge and access to contraceptives;                                                                  real win, so that people working on this goal see the purpose of                 What is more, you should reflect on the skills, knowledge and                                                      professional lives that relate to the areas of intervention of
     • Over the last 5 years, the number of people in our country                                                    working on it.                                                                   resources that are available in your operational team and what                                                     your organization or the female condom programming;
       contracting HIV/Aids has increased;                                                                                                                                                            you will need to be able to achieve your objectives and your                                                    4. Their participation in programming focused on HIV/Aids
     • Men and women in region X express a demand for the female                                                     Time bound: By stating a target deadline for the objective, and                  overall goal. At the same time, be aware that your environment                                                     control and/or sexual and reproductive health and family
       condom, but it is not available;                                                                              later on a time-line, there will be a sense of urgency and you will              may change, e.g. elections may be held or policy priorities might                                                  planning;
     • In our region, many people lack the skills to protect                                                         be in a position to track whether you are on schedule.                           change. Include this type of risk analysis in the documentation                                                 5. Their past collaboration with the implementation
       themselves against HIV infection.                                                                                                                                                              of your goal and objectives by trying to anticipate these                                                          organizations involved.
                                                                                                                     In addition to the use of the SMART-elements, you may add the                    changes.
     Your advocacy issue should be supported by research data                                                        policy actor or decision maker that you will target to make the                                                                                                                                  You should have a clear understanding of the decision making
     which may include focusing on the user level and/or analyses                                                    objective even more specific. For instance:                                      Setting the goal and objectives is strongly related to the third                                                processes in your country50:
     of public health reports by government, NGOs and research                                                                                                                                        step, identifying the target audience. When you know whom to                                                    in some countries, all decisions are made in national ministries
     institutions.48                                                                                                 • In one year’s time, female condom promoters have had one                       target, you may include that decision maker in your objectives.                                                 which give orders to their localized ministries. Alternatively,
                                                                                                                       or more contact moment(s) with relevant representatives                                                                                                                                        in other countries, the decision making power lies with the
                                                                                                                       of the Ministry of Health to discuss commitment to female                                                                                                                                      decentralized ministries or parliaments. In addition, you should
     3.2 Set overall goal and objectives                                                                               condom programming.                                                                                                                                                                            anticipate decision making moments so that you can plan well
     The problem that you have determined to be your advocacy                                                        • In two year’s time, the Ministry of Health in country X publicly                  Seyi Jamoh, hairdresser and HIV positive                                                                     in advance in order to influence the outcome of the decision
     issue needs a solution. Your advocacy is geared towards                                                           supports female condoms as a modern contraceptive choice.                         Lagos, Nigeria, 29 October 2009                                                                              making process. For instance:
     positively influencing the problem. You will set a goal, which is                                               • In four year’s time, the Ministry of Health has committed to                      “I also use them myself. I must protect myself. I have
     always long-term and which addresses your advocacy issue. For                                                     including female condoms into the next multi-annual national                      four children, three boys and a girl. Protection remains                                                     In country X, the national Ministry of Health revises the national
     instance, your goal might be:                                                                                     condom strategy.                                                                  necessary, even though I already have HIV. My husband                                                        condom strategy every 5 years, starting the process two years
                                                                                                                                                                                                         is also HIV positive, but he has a different form. We both                                                   before the current strategy ends.
     • In 5 years’ time, the government of country X has integrated                                                  You can also select objectives that will support your advocacy                      take antiretroviral drugs, but we must not complicate
       female condom programming in their national condom                                                            to decision makers, for instance by involving media or by                           matters further and infect each other. That would mean                                                       In this case, you know when to start your advocacy (at least
       strategy and has allocated sufficient resources to sustain it.                                                identifying influential “female condom champions” who have                          yet more medicines to swallow. I have no resistance to                                                       2 years before the strategy ends). At the same time you need
                                                                                                                     access to decision makers:                                                          new infections.                                                                                              to know how the government facilitates this revision process:
     Your long-term goal reminds you of where you are headed and                                                                                                                                                                                                                                                      is it open to civil society participation? Or is the new strategy
     when you would be satisfied about the impact of your advocacy                                                   • In one year’s time, at least 10 media outlets (radio, TV,                         Besides I don’t want any more children. And I have more                                                      written without any consultations?
     efforts. It is important to remember that your advocacy goal                                                      magazines, newspapers) have expressed themselves                                  fun in sex with the female condom. It touches the lining
     represents a policy change. It should include the action of                                                       positively with regard to the female condom.                                      of the vagina and enhances the pleasure; it stimulates the                                                   Or:
     decision makers, e.g. in this case, they have integrated female                                                 • In two year’s time, at least three champions have been                            vagina lining. Yes, it is more fun with one.”                                                                In region Y of country X, the local Ministry of Health drafts the
     condom programming into one of their policies and provide                                                         identified and have committed to promoting the integration                                                                                                                                     annual plan and budget for the public health facilities in that
     sufficient financial resources to sustain it.                                                                     of female condoms in the national condom strategy within                                                                                                                                       region in October of each year.
                                                                                                                       government structures.                                                         3.3 Identify Target Audience: advocacy towards the government
     In order to achieve your overall goal, you need short-term                                                                                                                                       Who are the people or institutions that have the power that                                                     In this case, you need to target the local Ministry of Health
     objectives that will lead you there. When identifying your short-                                               Needless to say, the identification of the advocacy goal and                     is required to bring about the desired policy change? This                                                      before and around October to have it include female condoms
     term objectives, you should specify them according to SMART-                                                    objectives is very context-specific and needs to be supported                    question is important when identifying your target audience.                                                    in the plans and budget for the public health facilities.
     criteria49:                                                                                                     by research and data collection. If you ask for an increase of                   As advocacy is a process aimed at decision makers and
                                                                                                                     funding for female condom promotion, you need to know how                        policy actors, your target audience is always someone in the                                                    Knowing who is the ultimate decision maker and when decision
                                                                                                                     much funding is spent on female condom promotion today. You                      government or parliament, for example: Ministry of Health,                                                      are being prepared and taken will help you to identify your
                                                                                                                                                                                                      Ministry of Finance or Planning, Ministry of Women and Gender,                                                  target and plan the timing of your advocacy efforts.

       48   Refer to the chapter 1: Process for more information on data collection to inform the design of your female condom program. This data may also be applicable to your advocacy strategy.
       49                                                                                                                                                                                               50   Refer to IPPF (2009) for an example of how to do analyze decision making processes and to assess where you can have influence: IPPF (2009), Generating Political Change, using advocacy to create political
            For more information on defining SMART advocacy objectives, please refer to: Networking for Policy Change: An Advocacy Training Manual by POLICY (January, 1999), page III-28.
            http://www.policyproject.com/pubs/AdvocacyManual.cfm.                                                                                                                                            commitment, page 35.




50                                                                                                                                                                                                                                                                                                                                                                                                                         51
     3.4 Build support                                                                                         3.5 Develop your message                                           Example of a one-minute message about the female condom:              Therefore, media publications may strengthen your advocacy
     Advocacy is not a process that should be executed in isolation.                                           Your advocacy message should be adapted to every specific                                                                                efforts by raising public awareness about the importance of the
     Finding supporters strengthens the advocacy message and                                                   target audience. Messages should ideally link to wider policy or   “Female condom programming is important for the health                issue and by holding government accountable.
     increases the credibility of the organizations that are advocating                                        public debates. You may do this by taking a specific angle that    and well-being of our population and urgently needed. In our
     for your cause. Supporters can be found in women’s groups,                                                will allow you to connect the female condom to a wider debate      country, one out of every twenty people is infected with HIV/         Another way to involve influential people is to have them take
     youth groups, men’s groups, among parliamentarians, health                                                e.g. by demonstrating how the female condom is complementary       Aids. Each day, 100 unintended pregnancies occur. The female          part in the official launch of your female condom program.
     practitioners, community leaders, gatekeepers and the                                                     to the male condom, by discussing the involvement of men as        condom protects against HIV/Aids as well as unintended                Ministry officials, parliamentarians, or members of national
     program’s peer educators. Choosing the right people with the                                              partners and role models, by addressing the empowerment of         pregnancy. The provision of female condoms would thus help            technical or implementing bodies could also be invited to
     appropriate networks and contacts will contribute to reaching                                             women to negotiate and use the condom, by emphasizing the          to keep our population healthy, but is not yet widely available.      become members of your program’s steering committee or
     out to policy makers and other influential leaders. Members                                               importance of the integration of the female condom into existing   Zawadi, a woman who visits our clinic, recently found out that        advisory board. 53
     of the advisory board or the steering committee may fulfill this                                          HIV/Aids and sexual and reproductive health initiatives, or by     she is HIV-positive, while her husband is not. She finds that
     role, as well as the executive directors of the organizations                                             advocating for the involvement of specific populations like        her husband does not like to use male condoms, but he is not
     involved. Every person or organization has certain skills,                                                people living with HIV/Aids, youth or women. Depending on the      opposed to female condoms. So they use them, but they are not
     contacts, and expertise that complement others.                                                           current policy debates and developments, your message may          regularly available. This increases the risk of infection with HIV/
                                                                                                               be more specific. Advocacy messages should always demand a         Aids as well as unintended pregnancy. We need to protect our
     In the advocacy network, it is recommended to come up with                                                policy change.                                                     population and you could play an important role in achieving
     a joint advocacy strategy to maximize impact and to avoid                                                                                                                    this. Your support to a higher budget allocation to female
     a variety of messages being delivered to decision makers.                                                 There are different kinds of messages that will enable you to      condom procurement and programming would be of great help
     There may be challenges too, people and organizations in                                                  reach your objectives and overall goal. This depends on the        and we would like to ask you to share your expertise with us on
     your network may have conflicting ideas or expectations of                                                level of support of the target audience.                           the budget process and to support the amendment to the budget
     the advocacy process. You may avoid conflicts by making                                                                                                                      that we are proposing.”
     agreements amongst each other before starting your advocacy                                               You can use sensitization messages to reach those decision
     strategy together.                                                                                        makers who do not know much about the problem, or the              Keep in mind that the way in which you deliver the message
                                                                                                               solution, or to what extent he/she has an influence in changing    is as important as the content of the message itself. When
     You may also find support among influential independent                                                   it. It is not likely that this category of decision makers will    presented orally, the message should be supported with
     individuals in society, who have access to decision makers and                                            support female condom promotion. Therefore, your messages          convincing body language and use of voice. When the message
     are willing to support your cause publicly. These people are                                              should be more descriptive but nonetheless convincing and          is written on paper, it should look attractive, the “tone” of the     Mascot for the female condom campaign in Cameroon, girl wearing
     often referred to as “champions”; they may be First Ladies, ex-                                           supported by evidence. Factsheets or sensitization meetings        language and use of sentences should appeal to the target             female condom dress
     members of parliament or government, or religious leaders.                                                are helpful. You may also involve media in this sensitization by   audience.
                                                                                                               publishing items about the female condom. 51
                                                                                                                                                                                                                                                        3.7 Raise funds
                                                                                                               When the decision makers or policy actors have gained more         3.6 Channels of communication                                         The funding of your advocacy efforts should be included
                                                                                                               understanding of the problem and your advocacy goal, you may       Messages may be disseminated in different ways. The channel           and budgeted for in your overall program design. In specific
                                                                                                               start to convey messages with a specific ‘ask’. You will need to   you choose depends on what would be the most effective                cases, additional campaigns that you did not anticipate may be
                                                                                                               let them know how they can take action. The elements of a one-     to reach your target audience. As discussed in the previous           necessary, which would merit a search for additional funding.
                                                                                                               minute-message (or elevator pitch) may be helpful:                 section, for the purpose of sensitization factsheets, policy          When advocating in a network of organizations and individuals,
                                                                                                                                                                                  reviews and informative workshops are a good way to convince          you may make agreements on who funds what and how much
                                                                                                               The one minute message52:                                          decision makers. When a person that you are targeting                 when executing the advocacy strategy.
                                                                                                                                                                                  is knowledgeable on the subject already, he or she may
                                                                                                               STATEMENT + EVIDENCE + EXAMPLE + ACTION DESIRED                    alternatively be reached with specific ‘asks’ in letters and face-
                                                                                                                                                                                  to-face meetings.
                                                                                                               Statement. In a couple of strong sentences, you express the                                                                                 Seyi Jamoh, hairdresser and HIV positive
                                                                                                               essence of your message                                            Decision makers and policy actors need information,                      Lagos, Nigeria, 29 October 2009
                                                                                                                                                                                  publications and samples of female condoms. They should be               “I talk about sex very openly. I just tell people that they
                                                                                                               Evidence. The statement should be supported by facts and/or        sent or given relevant material about your organizations and             must use condoms. Then they ask: “Me? What have I got
                                                                                                               figures to show the importance and urgency of the problem.         your goals, like an information sheet presenting the cause,              to do with a condom? I don’t have any diseases.’ I explain
                                                                                                                                                                                  its goals, objectives, and target groups, areas of intervention,         to them why it’s important. I also talk to young girls. They
                                                                                                               Example. Facts are important but also abstract. You should add     intervention strategies and implementation partners. Face-to-            must know what they’re doing. If you can’t abstain, I tell
                                                                                                               a human face to your story, which can be an anecdote based on      face meetings are important to build relationships. Sometimes            them, use condoms. I’m not in favor of abstinence; I just
                                                                                                               a personal experience.                                             it helps to invite foreign guests or media to the meeting to give        know it doesn’t work.”
                                                                                                                                                                                  the decision makers an opportunity to commit publically. Media
     Bishop Jolly Oyekpen of the Anglican Church, advocate for female                                          Action desired. Explain what the decision maker should do. It      involvement is important in positively influencing opinions
     condoms in Nigeria                                                                                        should be an invitation to act!                                    about the female condom of government and the general public.


       51   Based on IPPF (2009), Generating Political Change, using advocacy to create political commitment, page 12.
       52   Networking for Policy Change: An Advocacy Training Manual by POLICY (January, 1999), page III-54. http://www.policyproject.com/pubs/AdvocacyManual.cfm                  53   See chapter 2: How to govern your female condom program




52                                                                                                                                                                                                                                                                                                                        53
                                                                                                                                                                                                                     Case Study                                   Nigeria

     3.8 Develop your implementation plan                                                                                  4. Creating conducive environment outside of the policy
     All of the above steps compiled will result in your                                                                   field
     implementation plan, indicating the issue at stake, your overall                                                      In this chapter, advocacy is being presented as a process that      At the start of the female-condom program in Nigeria, the                            appreciate it when they are shown respect and feel that they
     goal and objectives, your time frame and budget, who will be                                                          targets policy and decision makers exclusively. It is important     Society of Family Health (SFH) was concerned that some                               should be the first to be told about the project to be carried out
     providing support, whom you will be targeting, how you are                                                            to note that there are many other people and institutions that      communities may not welcome the introduction of the female                           in the community. The community leader is also involved by
     going to identify messages and which communication channels                                                           exert influence and that may help you to create a supporting        condoms. SFH and Girls’ Power Initiative (GPI) and the CBO                           asking him which methods he thinks will be most effective in
     you will use. Specific activities may be added. See Annex 4 for                                                       environment for your female condom program. These may               located in Edo State identified strategies to gain access to the                     achieving the goals in his community. In this way, it becomes
     an example outline of an advocacy plan.                                                                               include community leaders, other gatekeepers, and donor             communities and acquire their trust.                                                 even clearer that his assistance is needed to carry out the
                                                                                                                           institutions.                                                                                                                                            project in the community.
     It is important to try and document commitments from decision                                                                                                                             First, the traditional leaders, known as the Odionwere or Ogie,
     makers so you can hold them to account. When a minister                                                                                                                                   were visited. Even though not said in so many words, according                       At the initial visits, a “friendly face” (this could also be the
     gives a speech about his support of the female condom, you                                                            4.1 Community leaders and gate keepers                              to tradition first time visitors are expected to bring a gift of                     community leader himself) was identified and phone numbers
     may publish an article quoting him/her on your website or in                                                          In the areas where female condom activities are taking place,       some sort to the palace. The guests are usually in the company                       were exchanged. By doing this, GPI keeps in touch with the
     media publications. Crucial in advocacy is the follow-up on                                                           it is important to recognize and engage the community leaders       of two or three elders and they bring drinks and kolanuts as                         community from a distance which is especially useful when
     commitments to make sure that they are actually translated into                                                       and gatekeepers. Community leaders and gatekeepers will often       gifts. It is important to be aware of local etiquette and customs                    something urgent takes place.
     real actions. Keep reminding relevant decision makers about                                                           share your concerns about the health and well being of the          when starting a program as it will help to ease access to the
     your cause, what they may do to contribute, and what they have                                                        people in their communities. It is helpful to look for common       community.                                                                           It takes time and effort to engage community leaders and
     committed to.                                                                                                         ground and how female condoms may contribute to alleviating                                                                                              gatekeepers. However, in Edo State it turned out that this
                                                                                                                           their concerns and the problems that exist in their communities.    SFH and GPI then selected contact persons in the communities                         approach was successful and that communities were quite
                                                                                                                           This will allow you to emphasize the added value of your female     to organize visits because they themselves had no way of                             receptive. By gaining support from community leaders, people
     3.9 Ongoing steps: Data Collection and Monitoring.                                                                    condom program by adopting their perspective.                       approaching the leaders. As well as gifts, materials such as                         were assured that the female condom program was addressing
     All steps in the advocacy process are to be supported by                                                                                                                                  newsletters, posters, leaflets, information bulletins and female                     their needs and benefiting them. The people were generally
     relevant data. The environment in which you are executing your                                                        They should be aware of the program’s objectives and activities     condoms were brought when visiting. Community leaders                                excited and curious to find out about the female condom.
     advocacy plan is dynamic. This means that the policy arena                                                            to facilitate the implementation process in their communities.
     needs to be monitored closely. Also, you need to keep a close                                                         Ideally, apart from giving consent to the program, community
     eye on staff turn-over in the government. What is more, new                                                           leaders and gatekeepers should also promote the female
     trends may gain popularity or new factual information may                                                             condom among their constituencies and facilitate field
     come up that requires you to adapt your original plan to fit the                                                      activities. Another way for them to be involved and supportive
     new situation. You should check your progress on your short-                                                          may be found in logistical matters e.g. arranging meeting spaces
     term objectives bi-annually. If necessary, you may have to adapt                                                      for sensitization meetings or helping to mobilize community
     your short-term objectives to the changing circumstances that                                                         members. This requires long-term relationship building,
     your monitoring assessment may reveal.                                                                                sensitization, and training sessions. Follow-up visits with         4.2 Donors and other institutions
                                                                                                                           these leaders and gatekeepers help to address concerns and          The field of sexual and reproductive health, family planning and                        Did you know...
                                                                                                                           questions. It also demonstrates that the implementers of the        HIV/Aids field involves many players. Apart from government                             ...That advocacy for the acceptance of the female
     3.10 Evaluation                                                                                                       program are willing and making an effort to work within existing    and civil society, there are donor institutions like UN agencies,                       condom is carried out at all levels: from the Prime
     Evaluating advocacy is difficult: you can not know for sure if                                                        community structures.                                               the Global Fund to fight Aids, Tuberculosis and Malaria,                                Minister to gatekeepers?
     a policy has been changed due to your efforts alone. There                                                                                                                                embassies and foundations. If there is an embassy or donor that
     are new trends in evaluating advocacy, which look at other                                                            You may come across leaders who are not convinced or even           is particularly supportive to the cause, it is important to invest
     outcomes apart from the policy outcomes. 54 At the start of your                                                      oppose the female condom and the planned activities. However,       in that relationship because they can be powerful advocates
     advocacy process, you should identify indicators that allow you                                                       their support or approval may be very important for the             for more funding from other donors. Mapping of these
     to evaluate your progress a couple of years later. Examples of                                                        program’s implementation. In that case, it is important to make     stakeholders55 will help to assess whether they can contribute
     indicators are:                                                                                                       sure that there is a continuous dialogue between you and the        to the female condom program in terms of support or funding.                            Uchugba Agsigi, motor taxi driver
                                                                                                                           opponent(s) to show them that the program objectives address        Media plays a big role in creating supportive environments as                           Benin City, Nigeria, 2 November 2009
     •    Level of funding for female condoms increased                                                                    public health concerns and that this will benefit the people.       well. How to involve media is discussed in the chapter 4: How to                        “I recently heard a radio jingle advertising female
     •    # of decision makers or policy actors reached                                                                    It may be easier to talk about public health rather than about      communicate with potential users.                                                       condoms. And I was at an information meeting about
     •    # of public commitments of decision makers or policy actors                                                      condom use when this is a particularly sensitive issue. Religion                                                                                            them. Yes the female condom is very good; naturally, it
     •    # of occasions in which you participated in policy dialogue                                                      may play a role in opposing the female condom. In some                                                                                                      prevents diseases, and it sees to it that you don’t infect
     •    # of media articles published which are calling for policy                                                       countries, it may be beneficial to involve church congregations.                                                                                            others. You never know who’s infected with what. When
          change                                                                                                           In cases where religious leaders have difficulties supporting the                                                                                           you meet a girl, you don’t know what she has. With this
                                                                                                                           female condom, it is helpful to continue to have a dialogue with                                                                                            we can protect ourselves. It’s a good product. It’s nice
                                                                                                                           them to have them communicate at least neutrally about the                                                                                                  and soft; you don’t notice anything.”
                                                                                                                           female condom.




         54   The publication of IPPF (2009) refers to good literature in this field. IPPF (2009), Generating Political Change, using advocacy to create political commitment, page 13.          54   Refer to Bibliography and Further Reading for an online power mapping tool.




54                                                                                                                                                                                                                                                                                                                                                       55
     Case Study

     Global Campaigning for Female Condoms                              It also provides a good photo opportunity for the media as the
     Zawadi Smartlove travels all over the world to tell people about   dolls make a beautiful colorful chain.
     the importance of the female condom. Zawadi is a paper doll,
     and there are thousands more like her. She is the heart of the     International advocacy
     Female Condom Paper Doll campaign of the Universal Access          An initial collection of 400 Zawadi paper dolls from over 20
     to Female Condoms Joint Programme. The campaign aims to            countries were presented at the United Nations High Level
     combine awareness-raising in different countries and advocacy      Meeting on HIV/Aids in New York in June 2011. This collection
     efforts at national and United Nations level.                      was used to bring the demand for female condoms to the
                                                                        attention of world leaders. The complete collection of dolls,
     People from all over the world write down their message            comprising of more than 1,000 from over 30 countries will               Amaka Nneji demonstrates the female condom on
     demanding female condoms on Zawadi paper dolls. These dolls        be presented at the ‘Prevention, Pleasure and Protection’               the market in Lagos, Nigeria
     are then collected and made into a long chain, representing        International Conference on Female Condoms in The
     the worldwide demand for female condoms. The strings of            Netherlands in November 2011 where they will be presented to
     dolls send the powerful message that there is a great demand       UNFPA, the Dutch government and others.
     for female condoms, from people all over the world. Female
     condoms can help to solve two of the greatest challenges the       Connecting the dots: Social Media
     world faces today: HIV/Aids and unintended pregnancy.              Via Facebook and Twitter, messages and pictures from the                Tips & Tricks
                                                                        different campaigns from all over the world are uploaded
     Local awareness raising                                            regularly. All people participating in the campaign can see             •	 Analyze	the	context	in	which	you	will	be	working	and	define	        need to be convinced? Also, it is valuable to know who
     The NGOs participating in the campaign use the paper dolls         who else is involved, and what is happening. This way the                  your issue accordingly.                                             opposes your aims and may do damage to your efforts.
     in their sensitization and awareness- raising meetings. The        participants are not only connected to those organizing the             •	 Set	your	overall	goal	and	related	objectives	thoughtfully:	         Try to build a dialogue with them to convince them to
     participants of such meetings can then have an active role         campaign, but also to one another. You can also join the                   what kind of political commitments will contribute to the           communicate at least neutrally about the female condom.
     by writing their message on a paper doll knowing that these        campaign by befriending Zawadi Smartlove on Facebook or                    female condom program? Make sure that your overall goal        •	   Develop	a	concrete	and	convincing	advocacy	message.
     messages will be presented to local as well as international       following her on Twitter.                                                  and objectives are ambitious enough but also realistic.        •	   Select	your	channels	of	communication	thoughtfully.	
     leaders later on. The Paper Doll Campaign now has over 30                                                                                  •	 Define	your	target	group:	who	has	most	influence?	Who	         •	   Reserve	adequate	funds	in	your	overall	programming	
     NGOs participating, from Argentina, Cameroon, Costa Rica,          A participative campaign                                                   would be a useful gatekeeper?                                       budget to cover your advocacy efforts and/or prepare to
     Kenya, Liberia, Mexico, New Zealand, Nigeria, Rwanda,              Local NGOs were not only asked to use the dolls in awareness            •	 Build	support	for	your	cause	by	involving	government	               raise additional funds for unforeseen advocacy projects.
     Tanzania, Thailand, United States of America, Venezuela and        raising and sensitization meetings. Because the paper dolls                officials, community leaders and other gatekeepers from the    •	   Appoint	an	advocacy	officer	based	on	a	specific	skill	set	
     Zimbabwe.                                                          were designed taking into account input from NGOs from                     start of implementation.                                            and personal characteristics, or allocate enough time
                                                                        different parts of the world, the dolls are, in this way, ‘owned’       •	 Analyze	your	support	base:	who	are	your	supporters	and	             for the overall operational team to engage in advocacy
     Local advocacy                                                     by them. The names of the dolls – three women and one man                  can help with your advocacy interventions? Which parties            activities.
     Once an NGO has gathered 50 messages or more, they are sent        – were also proposed and voted on by the participating NGOs                are doubtful about the use of the female condom and
     back to the Netherlands, from where the campaign is organized.     and on Facebook. Representatives of participating NGOs spoke
     However, before the dolls are sent back, they can be made into     at the event at the United Nations in New York. These and other
     a chain and a ‘fare-well party’ can be organized after inviting    forms of participation have been used to strive for ownership of
     local stakeholders, politicians and the media. This provides       the campaign by its participants.
     an advocacy moment and an opportunity to ask local leaders
     to write a commitment concerning female condoms on a doll.




                                                                                                                                                                                                                  Challenges
                                                                                                                                                                                                                  •	 Condom	use	is	a	challenging	subject	for	some	leaders.	Invest	
                                                                                                                                                                                                                     in a dialogue with them for them to support the female
                                                                                                                                                                                                                     condom or to at least communicate about it neutrally to their
                                                                                                                                                                                                                     constituencies.
                                                                                                                                                                                                                  •	 Community	leaders	may	want	a	share	of	the	donor	fund	if	
                                                                                                                                                                                                                     they see that there is a substantial amount of money involved
                                                                                                                                                                                                                     in a project reaching out to their community. Find out what
                                                                                                                                                                                                                     an appropriate reaction may be within the given context.




                                                                                  Positive Women Inc. and the YWCA of Aotearoa New Zealand
56                                                                                          have joined the International Paper Doll Campaign                                                                                                                                        57
     Chapter 6. Procurement and Supply Chain Management
     The availability of the female condom is of the utmost               wherever the female condom is sold or distributed, time and        2. What is procurement?56                                                                          outlets and peer educators in the communities with their supply
     importance to the success of your program. Once potential            space should be available to make the user feel comfortable        Procurement refers to the process of purchasing the female                                         of female condoms.
     users have been localized, sensitized and encouraged to              and to educate him or her. Outlets used for the sale of other      condom from international manufacturers and getting it into
     actually use the female condom, it should be available               contraceptive products, such as dispensers and condom              your country. It is an extensive process that includes the                                         International procurement of female condoms is a complex
     for the user, at all times, and at a variety of allocated            machines may therefore initially not be effective for female       following steps:                                                                                   process, and the duration of shipment may be inconsistent. It
     places. New users have not reached a stable level of                 condom sales. Female condom programming thus requires the          1. Purchase planning: Purchase planning involves the search                                        can take anywhere from a few days to several months to get
     consumption. Therefore, it is of great importance that they          identification of new outlets and, additionally, it may be the         for the supplier of the product that you need as well as                                       the female condoms shipped to your country. Beware that
     are not discouraged from using the female condom, simply             case that these outlets have no prior experience in supply chain       quality control. The Female Health Company manufactures                                        this inconsistency may disrupt the planning of your program.
     because of a lack of availability. Proper procurement and            management. Also, when existing outlets for other contraceptive        the FC2 female condom in a factory in Malaysia, the Women’s                                    Furthermore, the customs clearance of the products may require
     supply chain management is pivotal in ensuring the option            products include the female condom in their business, staff            Condom is manufactured by Dahua in China, and the Cupid                                        a lot of paper work as requested by the authorities, specifically
     of sustained use, which requires a long-term structural              members need to be trained to be able to adequately provide            female condom is manufactured by Cupid Ltd in India. 57                                        the pre-embarkation inspection certificate. It is recommended
     process to make sure that the product is able to keep                information on how to use the female condom.                       2. Price negotiation: The price you pay to the manufacturer                                        to be well informed about related procedures, so as to avoid
     moving in and out of the market smoothly.                                                                                                   directly influences the price you are going to have to ask of                                  major delays that will result in the unnecessary spending of
                                                                          This chapter describes the entire Procurement and Supply chain         the user. Because the cost of the female condom may be an                                      program funds. If you are not eligible for tax exemption, it is
                                                                          Management system for the female condom: from procurement,             obstacle for the user to buy it, it is important to put great                                  generally less costly to get a larger quantity of female condoms
     1. Introduction: Availability is key                                 to storage, to distribution mechanisms. In addition to logistics       effort into negotiating a good price with the manufacturer.                                    shipped and cleared at the same time. However, make sure
     When (potential) female condom users go to a sales point and         and administration, Procurement and Supply chain Management        3. Making the purchase: This requires significant paper work                                       that your organization has sufficient storage and distribution
     realize that the product is not readily available for purchase,      is about internal communication. It is important that the              and signing of contracts. You need to make agreements                                          capacities. If not, this can cause problems in terms of expiry
     this will result in disappointment and will likely negatively        different stakeholders in your program that are responsible            about the amount of female condoms purchased, the                                              dates and storage capacity.
     influence sustained use. Hence, availability of the female           for PSM communicate with one another clearly and effectively,          price that will be paid, the time frame of shipment, what
     condom is key. Sustained availability of the female condom will      to ensure that procurement, shipment, and distribution to              to do in case something goes wrong in the procurement
     encourage product uptake by new users as well as repeated use        warehouses, outlets and peer educators runs smoothly.                  process, etc. Your contract with the manufacturer needs                                        4. Testing
     of the female condom as a preferred contraceptive choice.                                                                                   to be actively monitored and your relationship managed.
                                                                                                                                                 This should include appropriate risk mitigation strategies
     Availability of the female condom is supported by a process                                                                                 and subsequent early corrective actions, if needed. If the
     called Procurement and Supply chain Management (PSM).                                                                                       purchasing is a continuous process, long-term agreements
     Procurement and Supply chain Management is the process                                                                                      may be made with the manufacturer.
     of purchasing the female condoms from the manufacturer,                                                                                 4. Establishing inventory control mechanisms: This is about
     shipping them to your country, storing it in warehouses and                                                                                 overseeing the constant and adequate supply of female
     depots, and organizing the logistics to get the female condoms                                                                              condoms, avoiding over-supply, or the products being out of
     to outlets, CBOs, public health centers and peer educators. The                                                                             stock. Consistency may be ensured by establishing a team or
     overall goal of PSM is to make sure that your product is moving                                                                             staff person to oversee the supply in the central warehouse.
     around continuously, i.e. that all segments of your supply chain                                                                            This will allow you to anticipate the need to purchase new
     are continuously stocked. This chapter describes the different                                                                              stock, whilst taking into account the time it takes to purchase
     stages in procurement and supply chain management. It also                                                                                  and ship.                                                                                      Female condoms are tested in this testing lab in Cameroon
     describes the different distribution strategies that you can pick
     from, e.g. distribution free of charge, offering samples, selling                                                                       The procurement of female condoms is often conducted by                                            The lead organization should always ensure that condoms are
     subsidized products, and selling at a profit.                                                                                           governments, donor agencies or United Nations agencies, such                                       being checked by the appropriate institutions that have been
                                                                          In Nigeria condoms are sold under the name “Elegance”              as UNFPA. Please note that currently, UNFPA procures only the                                      charged with quality control to ensure that condoms comply
     When engaging in female condom programming, PSM is                                                                                      generic FC2 female condom to the public sector. If you are to                                      with the quality standards and are not counterfeit products.
     inevitable. It is important to be aware of the fact that managing                                                                       proceed your programming by using a type of female condom                                          Some countries, depending on their national pharmaceutical
     a Procurement and Supply chain Management system truly is                                                                               that has not been approved by the current pre-qualification                                        legislation, require local quality testing of the product before
     a profession in itself. Some organizations may have expertise           Ndoumbe Lindgen Hans, Wholesaler                                agencies FDA or WHO, you will need a risk mitigation strategy. 58                                  receiving permission to distribute and sell it. The testing
     in this field, whereas others may have never engaged in it. You         Douala, Cameroon, 6 November 2010                                                                                                                                  laboratory tends to be part of government infrastructure. To
     may be responsible for all or for part of the PSM, e.g. you may be      “I think there is a high demand for the female condom.                                                                                                             illustrate: in the case of Cameroon, the government has been
     procuring the female condoms from the manufacturer, or you              I work with doctors and humorists to pass on my                 3. Shipment and customs clearance                                                                  testing the female condoms that were entering the country. As
     may be charged with ensuring that your peer educator and your           message. Sales have been increasing because I started           When female condoms have been purchased, the lead                                                  a result, the government is now assured that quality products
     drug store owner have a sufficient stock of female condoms              with 1O cartons per month and now I’m selling 5O cartons        organization of the program will receive timely information                                        are entering the country and will be able to identify counterfeit.
     available.                                                              every month. I sell mainly to establishments, which do          regarding shipment. The lead organization should make sure                                         Consequently, the government of Cameroon is now supporting
                                                                             not necessarily retail them. For example, I distribute to       that all stakeholders in the supply chain system are on stand-                                     the female condom. In other countries, pre-tested female
     Procurement and Supply chain Management for the female                  companies that have health centres. These centres have          by, e.g. the staff in the central warehouse and in regional                                        condoms may enter the country without further testing as they
     condom is distinct from that of other (contraceptive) products,         anti- HIV/AIDS programmes, but they lack the means.             warehouses and the staff driving the vehicles and supplying the                                    comply with international quality standards.
     like the male condom. This is because female condom                     So if you arrive there with an STD, you are doomed.”
     programming targets both men and women that visit a variety
     of distinct outlets. Additionally, female condom promotion and                                                                            56   The four steps are based on the definition of Procurement from www.businessdictionary.com
                                                                                                                                               57   New products by other manufacturers are under development.
     sales need adequate education and counseling. This means that,                                                                            58   Please refer to the Frequently Asked Questions annex.




58                                                                                                                                                                                                                                                                                                                   59
     5. Wrapping and packaging                                                                                    usually done in-country to avoid high costs and to be as time-            thumb is to send stock to facilities at least 6 months before it                                          8. Distribution through different channels
     The female condoms that you procured may arrive in your                                                      efficient as possible.                                                    expires. This will ensure that you will have enough time left                                             The most important question in terms of supply chain
     country in one of two ways:                                                                                  With regard to scenario (1a) and (2a), a concise user manual may          to distribute and sell it.                                                                                management is: how does the product get to the end user? A
     1. They either arrive in a generic factory wrapper, or;                                                      be developed that is included in the package that goes to the          5. Storage conditions: Storage conditions vary per female                                                    diversified and reliable distribution network is crucial in getting
     2. They are already branded when they arrive in your country                                                 end user.                                                                 condom type. You should inquire with the manufacturer to                                                  the female condom to its user. The user needs to be able to
        based on your negotiations with and instructions to the                                                                                                                             find out if your stock needs specific storage conditions. As                                              rely on the steady availability of the product, e.g. when going
        manufacturer. Therefore, they will be in your own uniquely                                                                                                                          the FC2 is resistant to humidity as well as high temperatures,                                            to a certain outlet or peer educator, he or she needs to be sure
        branded wrapper.                                                                                          6. Storage59                                                              its storage does not require special conditions. Different                                                that the female condom will be available there at all times.
                                                                                                                  Planning the storage of your female condoms in a warehouse                types of female condoms may require different handling.                                                   Additionally, the person selling the female condom needs to
     Based on the marketing strategy you have chosen, additional                                                  takes time and thorough planning. Your warehouse is a key                                                                                                                           be well informed and trained so as to be able to offer proper
     packaging may be necessary upon their arrival in your country.                                               facility in your supply chain and distribution strategy, and it                                                                                                                     information and counseling. Furthermore, diversification
                                                                                                                  is of the utmost importance that it is regarded in this way. The       7. Transportation                                                                                            of outlets ensures stability in sales rates and accessibility.
     When scenario (1) above applies, you may (a) package the                                                     following aspects are particularly important:                          The operational team of the female condom program plays an                                                   Distribution networks can be communal, pharmaceutical,
     generic female condom in an additional branded design                                                                                                                               important role in distributing the female condoms from the                                                   public, and commercial. Distributing the female condom is best
     package that is provided by the lead organization to                                                                                                                                central warehouse to regional or smaller warehouses. From                                                    done through existing distribution networks and supply chains
     complement the generic wrapper that it was provided to you                                                                                                                          there, the female condoms will have to find their way to outlets,                                            of other medical or reproductive health products.
     in; or, (b) you may leave it in the generic wrapper that it was                                                                                                                     health clinics, CBOs, and peer educators. Sadly, it sometimes
     packaged in at the factory and distribute it like that.                                                                                                                             happens that stocks of female condoms remain in the central                                                  When the female condom is newly introduced in a certain
                                                                                                                                                                                         warehouse due to the lack of a good supply chain management                                                  country or region, a lot of time needs to be invested in inter-
                                                                                                                                                                                         policy. You should attempt to avoid this at all times!                                                       personal communication. Therefore, at the start of a program,
                                                                                                                                                                                                                                                                                                      distribution and sales tend to go faster at sales locations
        Talye Elijah, man on the street, who had just bought a female                                                                                                                    After shipment and clearance, the lead organization may use                                                  where there is space and time for education and counseling.
        condom                                                                                                                                                                           two different ways of transferring the goods from the harbor to                                              Despite the fact that regular stores and supermarkets are easily
        Lagos, Nigeria, 29 October 2009                                                                                                                                                  the warehouse:                                                                                               accessible to the user, it may take some time before sales start
        “When I saw the posters up at the hairdresser’s, I went                                                                                                                          1. by using its own logistical structures and vehicles, or;                                                  increasing in these places, as staff here often does not have time
        in to ask what they were and how they worked. I became                                                    Condoms are stored in this warehouse for ACMS in Cameroon              2. by contracting agents to transfer the female condoms to                                                   to engage in education and counseling.
        enthusiastic immediately and tried one out. I run my own                                                                                                                            central warehouses.
        shop around the corner, in cosmetics. I am also going to                                                  1. Location: The warehouse building must be located at an
        sell female condoms. I’ve just heard where I can order                                                       appropriate location so that it allows you to meet your             Costs related to customs clearance and the transfer of goods
        them. They’ll be in my shop from next month. They’re so                                                      clients’ and customers’ delivery requirements. It is also           needs to be properly budgeted. Transfer of products from                                                         Irene Aimee Kubisa, owner 3rd Millennium Hair Salon
        good, everybody must use them.”                                                                              important to consider the availability of laborers as well as       central warehouses to decentralized stores must also be well                                                     Douala, Cameroon, 5 November 2010
                                                                                                                     road access in this respect.                                        funded to ensure the steady flow of products. Warehouses,                                                        “It was difficult at the beginning because women did
                                                                                                                  2. Managing storage: The areas in which you will store your            depots, and vehicles are often used for different products at                                                    not know about the female condom. So women had to be
                                                                                                                     stock of female condoms needs special care. The areas               the same time. The use of vehicles however is context-specific                                                   trained on how to use it. Sales are now picking up. We get
                                                                                                                     used for receiving and storing your stock must be prepared          and often depends on funding. Transporting female condoms                                                        monthly supplies, so we always have sufficient stock. I
                                                                                                                     and cleaned. Packages must be inspected to make sure that           may be regarded as less of a priority as compared to the other                                                   have customers who buy a carton of 1O condoms every
                                                                                                                     damaged products are being separated from usable stock. If          products that need transportation. It may therefore be helpful to                                                month. I also have customers who stop by once in a while
                                                                                                                     damaged products are discovered while the delivery truck            allocate specific vehicles for transportation of female condom                                                   to get the female condom.”
                                                                                                                     is still at your site, you may refuse to accept the products. If    stocks.
                                                                                                                     damaged products are discovered after the delivery truck
                                                                                                                     has departed, you should follow the procedures for handling         Within the lead organization, a supply chain manager or PSM                                                  8.1 Community-level: Peer educators and CBOs60
                                                                                                                     damaged stock.                                                      team should be available to design an appropriate PSM plan,                                                  Inter-personal communication (lPC) sessions by peer educators
                                                                                                                  3. Arranging stock: Female condom boxes are arranged                   to manage all activities in the warehouse and storages, and to                                               and CBOs are an effective way to present the female condom
                                                                                                                     on pallets. When stored, the pallets must be at least 10            procure and supply the program with a steady amount of female                                                to a wider audience. It equips potential users with essential
                                                                                                                     centimeters above floor level, at least 30 centimeters away         condoms.                                                                                                     information, and offers them an opportunity to have a look at
                                                                                                                     from walls and other stacks, and can be stacked no more                                                                                                                          and even touch and feel the product. Arousing the curiosity
     Female condoms in warehouse in Nigeria                                                                          than 2,5 meters high. The following information must be                                                                                                                          of your audience may lead them to eventually want to try the
                                                                                                                     clearly visible on your boxes: labels, expiry dates, and                                                                                                                         female condom. Peer educators may reply to questions or
     When scenario (2) above applies, you may (a) package the                                                        manufacturing dates.                                                   Did you know...                                                                                           concerns on the spot. People tend to feel more comfortable
     branded female condom into a box or other type of package that                                               4. Stock rotation: When issuing products, it is important to              ...That the social marketing programme in Zimbabwe                                                        purchasing a female condom from a peer educator than from
     complements the branded wrapper that is was provided to you                                                     follow the FEFO policy: “First Expired, First Out”. To facilitate      has over a thousand hair salons and barber shops                                                          other points of service.
     in; or, (b) you may leave it in the branded wrapper that it was                                                 this, it is easiest to place products that will expire first in        distributing the female condom?
     packaged in at the factory and distribute it like that. Step (2a) is                                            front of products with a later expiry date. A general rule of



       59   This section draws from “Guidelines for the storage of essential medicines and other health commodities”, by DELIVER, JSI, WHO, UNICEF and USAID, December 2003.               60   Refer to chapter 3: Community Approaches and Chapter 4: How to communicate with potential users for more information on the work of peer educators and CBOs.




60                                                                                                                                                                                                                                                                                                                                                                          61
                                                                                                                                                       10. Distribution                                                      10.2 Selling the female condom
                                                                                                                                                       Distribution can be done in several ways: distribution free of        Selling the female condom has certain advantages over free
                                                                                                                                                       charge, selling subsidized products, giving out samples, or           distribution. First and foremost, distributors tend to be more
                                                                                                                                                       selling at a profit.                                                  interested in getting the product to the user if they will make
                                                                                                                                                                                                                             a profit. At the same time, in the process of selling and buying,
                                                                                                                                                                                                                             there is time and space to educate the buyer in how to use the
                                                                                                                                                                                                                             product. If the user visits the same selling point over and over
                                                                                                                                                          Dr. Rudolf Kunchu Nintai, Pharmacist at Noble Pharmacy             again, it is easier to follow and locate the user and find out
                                                                                                                                                          Bamenda, Cameroon, 2 November 2010                                 whether the product has been used correctly and in a sustained
                                                                                                                                                          We sold 2O female condoms in September when the                    manner. Lastly, some people may appreciate the product more
                                                                                                                                                          schools were reopening. That’s our average sales per               when they are paying for it.
                                                                                                                                                          month. Some parents came here with their sons and
                                                                                                                                                          daughters. I can confidently tell you that when the                Selling the female condom can be done in two ways:
                                                                                                                                                          schools were reopening, one parent came here with                  • Subsidized: Since female condoms are more expensive than
                                                                                                                                                          her daughter and she bought quite a quantity of female                male condoms, people may choose not to buy the female
                                                                                                                                                          condoms for her. The daughter was laughing but she                    condom for that reason and even not to try if the female
                                                                                                                                                          took them. I was happy and gave them a few more free                  condom is an option for them altogether. That is why selling
     Elvis Oviasuyi and his wife in their chemist shop in Nigeria where they                                                                              samples. Maybe when you visit next time we will be able               the female condom at a subsidized price may contribute
     sell female condoms                                                                                                                                  to update you on this trend. Hopefully, sales will go up in           to greater accessibility. This is often done through social
                                                                                                                                                          the future.                                                           marketing.61
                                                                                  Elvis Oviasuyi, pharmacist                                                                                                                 • For profit: Female condoms are sold for the actual cost of the
     8.2 Pharmacies and drug stores                                               Benin City, Nigeria, 2 November 2009                                                                                                          product, plus a small margin which will profit the seller. This
     Pharmacies and local drug stores tend to be visited by                       “I’m now trying to sell them in my shop. There clearly is a          10.1 Distribution free of charge                                         is usually the case in the commercial sector. For the female
     customers seeking non-prescription medicines and health                      demand. Women, men too, want to buy them. But stocks                 Giving out the female condom free of charge has a major                  condom this is still uncommon. Because it is a fairly new
     products. Local drug stores, which are often small-merchandise               soon run out and at the moment I can’t get new stocks.               advantage in the accessibility of the product: in this way, the          product that addresses major public health concerns, it is
     kiosks that include the sale of non-prescription health items, are           When I had them, we sold a box of 24 every day but, if               cost of the product is not an obstacle for women and men to              subsidized and made available in through the public sector
     located in even the remotest villages and are therefore perfect              more were available, sales would certainly double.”                  buy and try the female condom. It also increases the visibility          in many countries. For now, the focus is still on accessibility
     outlets for selling the female condom.                                                                                                            of the product, which can contribute to its normalization. Free          and normalizing the product as a contraceptive choice.
                                                                                                                                                       distribution is often done through the non-commercial sector,            Therefore, subsidized pricing is still the dominant sales
                                                                               9. Keeping Stock                                                        e.g. through public health centers, but also through NGOs/CBOs           strategy.
     8.3 Non-traditional outlets                                               The key to encouraging users’ confidence in and sustained               when a donor purchased the female condoms to be distributed
     The female condoms may be sold in a variety of outlets.                   use of the female condom is in its availability. Once demand            freely.                                                               In order for private sector parties to integrate the female
     Supermarkets, hotel reception desks, hair dressing salons,                for the female condom has been created, the product should                                                                                    condom into their regular stock, incentives need to be created
     barbershops, street vendors, and roadside kiosks are examples             be available for purchase or hand out at all times. A staff             Alternatively, free distribution of the female condom may             to make it worthwhile to invest time in training and capacity
     of non-traditional outlets for the female condom. Involving               member should be appointed to oversee that all sales points             present difficulties, some of which are mentioned below:              building to educate the consumer on how to use the condom.
     these outlets in your network increases access to the female              and dispensers are restocked before running out of product.             • Education and counseling opportunities: People need proper          Incentives for private sector partners include the prospect of
     condoms for both women and men. Additionally, offering                    Keeping stock properly is what builds your organization’s                  instructions for correct use and need to be reassured that it      making a profit and of expanding their customer base.
     the product in places that people visit in their daily routines           reputation and reliability.                                                needs practice. When giving out female condoms for free,
     contributes to normalization of female condom use.                                                                                                   there may be less of an opportunity to talk to the potential
                                                                               Keeping stock ultimately starts by making sure enough product              users and to address their questions and concerns.                 10.3 Sampling
                                                                               reaches your country, so that you can adequately respond to             • User identification: When the female condoms are being              Female condom use needs practice before women and men
     8.4 Public health system                                                  the demand. Transportation systems, warehouse and storage                  provided in dispensers in public places or handed out for          will choose it as their preferred contraceptive method. Free
     The female condom may also be distributed through your                    management need to function properly in order to keep                      free, it may be difficult to identify users and find out whether   sampling enables potential users to try it, before they are
     public health system. Often, the government is responsible for            your stock flowing. Both outlets and peer educators carry                  they have used the product correctly, what their experience        willing to actually pay for the product. Sampling is often done
     supplying the different public health locations, which can be             responsibility for monitoring their stock and asking for more              was, and whether they are interested in using the female           with socially marketed female condoms and in the commercial
     pre- and post-natal care services, family planning centers, and           stock well in advance of running out. Some organizations                   condom more often.                                                 sector. A successful way of sampling is to offer the user a “buy
     HIV/Aids voluntary counseling and testing (VCT) clinics.                  appoint a sales team, which monitors the stock and sales of all         • Trust: Some people may be suspicious when receiving things          one, get one for free” deal.
                                                                               outlets in a certain region. Stocking is best done through a “First        for free and would rather pay a little money so that they will
                                                                               In, First Out” (or a “First Expired, First Out”) principle to prevent      feel as if it is a trustworthy product.
                                                                               product expiry. It is important to keep the “pipeline” stocked,         • Other purposes: Freely distributed condoms may be
                                                                               meaning that all segments of the supply chain (warehouses,                 resold to a third party or used for other purposes than as a
        Did you know...                                                        depots, outlets, peer educators and CBOs) should have stock                contraceptive method.
        ... That two of the 16 CBOs have health care facilities?               at all times. This means that you will need to purchase more
                                                                               products than you are expected to sell or distribute.

                                                                                                                                                         61   See chapter 8: Creating demand, increasing access.




62                                                                                                                                                                                                                                                                                                63
                                            Non-Commercial                 Social Marketing                  Commercial                       12. Corporate Social Responsibility                                  13. Female condom demonstration models
                                                                                                                                              An approach worthwhile exploring may be the engagement               Female condom demonstration models are used for female
      Free distribution                     X                                                                                                 of private sector companies, such as soda companies or               condom training and demonstrations. A demonstration model
                                                                                                                                              food suppliers, so that they may help distributing the female        shows the labia and vagina up to the cervix. The representation
      Sales: subsidized                                                    X                                                                  condom by using their national distribution networks. For            is simplified for didactic reasons and is designed so that
                                                                                                                                              them, contributing to the improvement of general public              it offers you the opportunity to properly demonstrate
      Sampling                                                             X                                 X                                health by offering distribution services will be perceived as a      the insertion of a female condom. To ensure efficient
                                                                                                                                              social responsibility. Field marketeers and merchandisers may        training, education and inter-personal communication, it is
      Sales: for a profit                                                                                    X                                promote the acceptability of female condoms along with their         recommended to make sure you have enough female condom
                                                                                                                                              products, thereby ensuring product visibility. Local wholesalers     demonstration models available for every staff member that
                                                                                                                                              that work with these private sector companies will often turn        is involved in these activities, e.g. trainers, trainees, peer
                                                                                                                                              out to be key distributors for liquor outlets and grocery shops in   educators, community leaders, barbers, hairdressers, etc.
     11. Complementary approach                                            ones monitoring female condom distribution channels of the         remote areas. This will offer you the opportunity to more easily     Hence, it is essential that you budget accordingly to allow for
     To avoid duplication and competition in the non-commercial,           non-commercial, social marketing, and commercial sectors.          distribute female condom stocks to remote areas. In return,          the sufficient purchasing of models. It is important to note that
     social marketing and commercial sectors, distribution                                                                                    female condom programmers may also encourage the pairing             the process of procurement for female condom demonstration
     channels should be clearly defined. The different channels are        Note that, in some countries, the government may not allow         of female condoms with other women-focused products in               models is comparable to the one for female condoms. Hence,
     complementary and can support each other when one of the              identical packaging of freely distributed female condoms and       hair salons to make sure it fits the companies’ regular business.    you should plan well in advance!
     channels faces difficulties in distribution and supplying. It is      socially marketed female condoms. In that case, the socially       Despite the obvious benefits of partnering with a private sector
     therefore recommended to maintain close relations with the            marketed condoms will need to be rebranded.                        company, do always thoroughly consider the implications
                                                                                                                                              of association, e.g. openly linking your female condom to a
                                                                                                                                              local beer company may have negative consequences for the
                                                                                                                                              reputation of female condom use.




                   Case Study                     Cameroon                                                                                    Tips & Tricks
                                                                                                                                              •	 Procurement	and	Supply	chain	management	is	all	about	             •	 Make	sure	to	closely	monitor	the	stocks	in	your	entire	
                                                                                                                                                 impeccable planning!                                                 supply chain to ensure accessibility and availability.
                                                                                                                                              •	 It	is	useful	to	appoint	a	supply	chain	manager	or	team	to	        •	 You	may	apply	a	“buy	one,	get	one	for	free”	approach	to	
     When starting the large-scale female condom program, female           Subsidized sales aim to realize acceptance and adoption of            oversee the PSM process.                                             attract new users.
     condoms were relatively new to people in Cameroon, and the            the product. People who want to use the female condom can          •	 Make	sure	to	purchase	your	female	condoms	at	least	6	             •	 It	is	important	to	keep	the	“pipeline”	stocked,	meaning	
     product was faced with many prejudices. To counter these              buy it for a reasonable price at different commercial locations,      months prior to the envisioned start of your program’s               that all channels in the supply chain (warehouses, depots,
     prejudices and to create incentives to use the female condom,         for example:                                                          implementation.                                                      outlets, peer educators, and CBOs) should have stock at
     ACMS uses different distribution approaches: free distribution        • Hairdressing salons,                                             •	 Make	sure	to	distribute	your	female	condoms	through	a	               all times. This means that you will need to purchase more
     and subsidized sales.                                                 • Pharmacies                                                          variety of existing networks and supply chains.                      products than you are expected to sell / give out.
                                                                           • Commercial wholesalers.
     Free distribution addresses the curiosity of the potential users
     by letting them see, feel and try the product. Free distribution is   ACMS now sees that the quantities of female condoms
     implemented through:                                                  distributed for free are decreasing, as people in Cameroon
     • The partnership with the Cameroonian branch of Society              become accustomed to the female condom as a contraceptive
        for Women and AIDS in Africa (SWAA), which receives 7,700          method. Nevertheless, ACMS continues to implement these two
        female condoms each month;                                         approaches as they rapidly give more publicity to the product
     • Civil society implementing partners of the project and              and further its acceptance.
        hairdressing salons that receive samples;
     • Companies and United Nations agencies that acquire female           Buy one and get one free!
        condoms for their employees;                                       ACMS introduced a successful strategy to increase the user’s          Did you know...                                                   Challenges
     • Internal teams of the ACMS that distribute female condoms           curiosity, acceptance and adoption in one go. They made               ...That approximately 10 million FC1s and FC2s were
        during special public events, such as International Women’s        information leaflets which included two female condoms. They          purchased and shipped by USAID IN 2009 making it                  •	 Bureaucratic	procedures	in	procurement	and	customs	
        Day, World AIDS Day, and HIV voluntary counseling and              asked the potential users to “buy one and get one free”. The          the largest ever US female condom shipment during                    clearing may result in the inconsistent supply of your female
        testing events.                                                    user received a 50% discount on the product and was given two         a calendar year?                                                     condoms. This should be taken into account when you are
                                                                           female condoms to try. This approach is very popular and works                                                                             planning and budgeting for your program.
                                                                           well immediately after the introduction: female condom sales                                                                            •	 Keeping	stock	at	all	levels	of	the	supply	chain	requires	
                                                                           increase immediately.                                                                                                                      profound logistical skills. Beware not to underestimate this!




64                                                                                                                                                                                                                                                                                     65
     Chapter 7. The involvement of men: It takes two to tango
     Couples are at stake when it comes to decision making              Context-specific strategies to involve and engage men in
     regarding Sexual and Reproductive Health (SRH) and                 using the female condom are pivotal to overcome these
     family planning. Hence in female condom promotion,                 social and cultural barriers. For example: female condom
     men are an important part of the equation too. Female              programming should promote partner support, consensual
     condom promotion is not merely a matter of explaining              sexual relationships and negotiation. Actively involving men
     to women how to use the product. Rather, in order to be            has advantages in this regard, such as the protection of the
     successful, you need to address a variety of issues that may       couple and the family, increased respect for the woman by the
     be socially or culturally sensitive. Sexual relationships,         man, promotion of gender equality, and overall acceptance of
     sexual pleasure and sex negotiation between men and                the product by both men and women. Men who use the female
     women are not topics that many people will discuss openly.         condom show that they are not only concerned about their own
     These discussions form the backbone of our work and it is          health, but also care about their partner and their relationship.
     important to be aware of the fact that men and women need          In this light, specific messages should be developed in order to
     to be targeted equally in your programming. This chapter           convince men that female condom use is worthwhile.
     describes some of the strategies that you may use to target
     and involve men in female condom promotion: by using
     specific media campaigns, by adapting messages so that
     they will appeal to men, by using specific role models, and
     by identifying locations where you will reach men more                Did you know...
     easily.                                                               ...That in Nigeria, apart from married couples, mainly
                                                                           young single men (age 18-28) are interested in the female
                                                                           condom? (male involvement)

        Did you know...
        ...That in Cameroon, Nigeria and Zimbabwe, barbers
        act as peer educators for other men and their shops                                                                                 A group of men receive
        serve as outlets for the female condom?                                                                                             information and instructions on how to use                         Did you know...
                                                                           Lead trainer Nigeria:                                            the female condom                                                  ...That in Nigeria, some men come along with their
                                                                           “Men are more curious and ready to experiment the                                                                                   female partners to sensitization meetings and seem
                                                                           usage of the female condom, and are more willing to                                                                                 more eager to experiment with the female condom
                                                                           use it than women.”                                                                                                                 than women?
     1. Introduction: What’s in a name?
     “Female condoms” seem to automatically refer to women. In the                                                                             Lady, Commercial Officer, Radio Hot Cocoa
     past, female condom programmers have sometimes interpreted                                                                                Bamenda, Cameroon, 3 November 2010
     this as a reason to reach out exclusively to women. However—if     2. How to use the media for promotional purposes                       Why did you decide to promote the female condom?
     you aim for your program to have a real sustainable impact—it      Communications should initially focus on the couple (married           “I wanted to create awareness about the female condom        3. How to adapt your messages to attract men’s attention
     is important to be aware of the fact that men need to be           or unmarried). To sufficiently attract men’s attention, media          and to encourage not only the girls but also the boys to     Reaching out to men means adapting the messages, locations
     involved equally. Using a female condom requires both              and promotion campaigns should also contain messages                   use the female condom, especially those boys who are         and sensitization strategies to what men want to hear and
     partners’ consent. Additionally, partner support in sexual         that are attractive to men, that empower them to initiate a            shy.                                                         where they can be found. Information, education and
     relations and contraceptive choice is essential in promoting a     dialogue concerning family planning and condom use, and that                                                                        communication events should also target places where many
     safe, healthy and pleasurable sex life, for both women and men:    encourage them to buy the female condom.                               We mainly broadcast the advert. Many people get to           men go, such as barbers, bars, work places, uniformed forces’
     it takes two to tango.                                                                                                                    know about the female condom through these adverts. I        camps, and market places. Some professions are executed
                                                                                                                                               don’t use it myself but I persuade other women to use it.    exclusively by men and provide a service to men, such as
     Promotion of the female condom, being a women-controlled           “Condoms for men who want the best for women.”                         We also use posters and calendars to promote the female      barbers, policemen, taxi drivers, DJs, and journalists. It is very
     method, therefore presents us with an additional challenge.        Media campaign in Cameroon promoting the female condom.                condom. Besides this, we had an interactive programme        powerful if these men convey a positive message on the female
     The female condom explicitly addresses the woman’s                                                                                        where listeners can call in to contribute by giving their    condom as this may engage and convince fellow men.
     sexuality, thereby empowering her to protect herself against                                                                              opinion or asking questions. Some of the girls have
     pregnancy, HIV/Aids and other Sexually Transmitted Infections.     The involvement of men in the campaign will portray the female         complained that when they wanted to use the female           In terms of developing your message, it is important to include
     Nonetheless, she will often face gender inequality and power       condom as an attractive product for men who care for their             condom the boys objected by saying they wanted to do         a clear statement as to how the female condom benefits men.
     imbalances in her sexual relations: in practice, it often turns    partners. When broadcasting a video clip or commercial, there          it naturally. This is a good reason for discussion. We try   Please find some examples below:
     out that women are targeted exclusively by female condom           should be an appropriate balance between the number of men             to talk about the consequences of unsafe sex. You know,      • The female condom may be inserted into the vagina before
     programming, whilst it will often be the man that decides          and women that are being shown. Community radio stations               the boys can easily convince a young girl to have sex            the start of the sexual intercourse. So: no interruptions are
     when and how to have sex. Hence, despite the fact that many        offer another communication channel with which to reach out            with them. This is why we find it really important to talk       required in “the heat of the moment”.
     programmers will agree that a focus on the couple is pivotal, it   to men. When designing a promotion campaign, the wishes and            about a subject such as the female condom. We try to         • Men will feel free during intercourse, when using the female
     nonetheless often proves to be difficult to meaningfully engage    concerns of men should be included in the focus of the research        convince the boys to always use a condom. We also have           condom: there is no tight male condom around the penis
     men in sexual and reproductive health matters in general—and       that will inform campaign design.                                      a Pidgin English programme where we talk about the use       • Both partners are free from worries during sex as the female
     in female condom use and promotion in particular.                                                                                         of condoms and the dangers of not using condoms.”                condom offers dual protection against pregnancies, HIV/




66                                                                                                                                                                                                                                                                               67
       Aids and other Sexually Transmitted Infections.
     • The female condom offers a good method for showing care                             Marie Madelene Bakong, married and mother
       for the woman, himself, as well as the relationship.                                Buea, Cameroon, 5 November 2010
     • The female condom adds to joint sexual pleasure: both the                           “My husband did not want us to continue having children
       woman and the man will enjoy.                                                       but he hated the male condom. So I got pregnant all the
                                                                                           time. Sometimes we would not make love for weeks
                                                                                           because of this. One day my hairdresser introduced the
     3.1 Using role models to spread the word                                              female condom to me when I came to have my hair done.
     An effective way to convince men to try the female condom is by                       I took one home and tried to insert it myself. When my
     having male role models in society spread the positive message.                       husband came home in the evening, I told him about
     These may include musicians, football players, religious leaders                      the new condom I learned about but he was not very
     or politicians. These role models will need support from the                          interested and still did not want to make love with me. I
     stakeholders involved in the female condom program to convey                          came back to my hairdresser and she advised me how to
     accurate messages.                                                                    negotiate with my husband so that he would accept the
                                                                                           female condom. And behold, I used the right approach
                                                                                           and my husband got curious. That night he inserted the
     4. Partnerships will contribute to your cause                                         female condom himself. And he enjoyed making love                                                                                       Did you know...
     In some countries, so-called “MenEngagement” networks                                 with it. He even told me I should have told him long ago                                                                                ...That in Cameroon, currently more men than women
     mobilize men who will stir the public debate on gender                                that the female condom was much better than the male                                                                                    buy the female condom?
                                                                                                                                                            Elegance poster in Nigeria
     equality, masculinities, and the sexual and reproductive health                       condom.”
     of men and women. 62 These networks and NGOs can assist in
     developing strategies to promote female condoms on the basis                                                                                                                                                                  Did you know...
     of gender equality in your country.                                                                                                                                                                                           ...That barbers sell more quantities of female
                                                                                                                                                                                                                                   condoms than their female counterparts?



                                                                                                                                                            Tips & Tricks
                                                                                                                                                            •	 Make	sure	to	appoint	male	peer	educators.	                       •	 Involve	male	role	models	to	reach	out	to	other	men.	
                                                                                                                                                            •	 Make	sure	to	build	your	supervisory	body	on	the	basis	of	        •	 Integrate	female	condom	messages	into	other	programming,	
                                                                                                                                                               gender balance.                                                     such as programs focused on male condom use, male
                                                                                                                                                            •	 Involve	men	who	work	with	fellow	men	on	a	daily	                    circumcision, dual protection, and consensual sexual
                                                                                                                                                               basis, such as barbers, policemen, taxi drivers, DJs, and           partnerships.
                                                                                                                                                               journalists.                                                     •	 Work	with	men’s	(engagement)	networks.
                          Case Study                                   Mozambique                                                                           •	 Make	sure	that	your	media	messages	and	promotion	                •	 Positioning	the	female	condom	as	a	tool	to	ensure	the	health	
                                                                                                                                                               campaigns for the female condom are male friendly:                  of both the woman and her partner.
                                                                                                                                                               emphasize how the female condom benefits both women              •	 Position	the	female	condom	as	a	tool	that	adds	to	sexual	
                                                                                                                                                               and men!                                                            pleasure and worry-free sex for both the woman and her
                                                                                                                                                            •	 Involve	men	in	the	design,	implementation	and	evaluation	           partner.
                                                                                                                                                               of the female condom promotion campaign.
     In Mozambique, Fórum Muhler and partners launched a pilot                          A result of this pilot initiative was the creation of the Rede de
     initiative to get more men involved in HIV/Aids programs. The                      Homens pela Mudança (‘Network of Men for Change’) that today
     aim of this pilot is to raise awareness among men concerning                       unites several civil society associations that are fighting for
     the reduction of feminization of HIV/Aids.                                         the promotion of gender equality. The Rede de Homens pela
                                                                                        Mudanca has performed various training activities targeting
     In its first phase, the so called Parceiros H (‘Men as Partners’)                  the youth of the city of Maputo. It has also set up restricted
     program was based on the training of young activists,                              discussion groups, engaged in public debates and campaigns
     including young members of other Mozambican civil society                          against domestic violence. In addition, some studies have been      Challenges
     organizations. These initial trainings focused on themes like:                     done concerning the participation of men in promoting sexual
     Gender and Masculinity, HIV and Aids, Gender and Violence,                         and reproductive health.                                            •	 Strong	social	and	cultural	taboos	surrounding	sexual	issues	
     Sexual and Reproductive Health, and Culture and Tradition. The                                                                                            may form a barrier to men’s involvement in the promotion
     program covered three provinces in Mozambique.                                                                                                            and use of female condoms. Make sure to design context-
                                                                                                                                                               specific strategies that may tackle related challenges.
                                                                                                                                                            •	 Messages	that	target	men	are	different	from	those	that	target	
                                                                                                                                                               women. Finding a message that helps to encourage men’s
       62
                                                                                                                                                               involvement in family planning and condom use takes time!
            For example, refer to the MenEngage Global Alliance: http://menengage.org




68                                                                                                                                                                                                                                                                                                 69
     Chapter 8. Creating demand, increasing access
     When the female condom as a contraceptive method is                                                                                                                                                          Most importantly, social marketing creates demand by
     commonly unknown, it is most important to start your                                                                                       Joyce Adesanye, 56 years                                          thinking from the audience’s perspective: don’t ask what
     program by investing in awareness raising, the creation of            Did you know...                                                      Church leader Omipanu neighborhood                                people need, ask what they want! All too often, marketing
     demand and increased access to the female condom. This                That in Lagos, Nigeria, the number of outlets selling                Nigeria, Lagos, 29 October 2009                                   approaches take a patronizing approach of “we know best
     may be done in a variety of ways and should ideally involve           the female condom increased from 45% to 95% in                       “I’m a church leader of the Christ Church for All Nations.        what is good for you”. This approach generally proves to
     a range of sectors and stakeholders. This chapter highlights          two years?                                                           I was there this morning. A woman who had lost her                be counterproductive. Instead, there is a great opportunity
     building partnerships with parties in both the non-                                                                                        husband just before her child was born spoke to me.               to market the female condom as something that will help
     commercial public and the commercial private sectors, and                                                                                  She’s alone. She’s still young. There is a new man seeing         people to get what they want, e.g. sexual pleasure, peace of
     how these may contribute to increased access to the female                                                                                 her; she doesn’t want any more children, so I tell her to         mind, protection, control of sexual and reproductive health,
     condom. Additionally, social marketing is emphasized as a          2. Partnerships with public and private sector players                  use the female condom when she sleeps with him. She               etc.
     useful way to connect the two sectors in creating demand as        Female condoms may be made available by different players:              wants to use them, so I’m making sure she gets them.”
     well as greater and sustained access to the female condom.

                                                                        2.1 Non-commercial, not-for-profit                                   3. Social marketing: Our good practice!                                 Did you know...
     1. Introduction: Team up and wise up!                              A. Government, (public) health: Female condoms may be                As explained above, in both sectors —public and private—                That in Cameroon annual competitions are organized
     This chapter outlines the different sectors in society that you    made accessible through public channels, which means they            demand for the female condom is often lagging behind. In                for hairdressers based on who sells the most female
     may team up with to ensure access to the female condom. There      may be available at government clinics and hospitals. Often,         our experience, social marketing has proven to be a useful              condoms? The winners in the different regions are
     is the non-commercial not-for-profit sector that makes the         governments collaborate with UNFPA to procure the type of            strategy in creating demand and increasing access to the female         displayed on a poster shown in all hairdressing salons.
     female condom available in public centers like clinics, family     female condoms that are pre-branded by the manufacturer.             condom. At the same time, both the public and private sectors
     planning centers, HIV/Aids voluntary counseling and testing        They will usually offer them for free when a woman comes for         are strengthened as social marketing works from within existing
     centers, and at some NGOs/CBOs. Then there is the private          her health check, for advice on family planning, or when she         (distribution) structures. Overall demand for the female condom
     sector that sells the female condom for a profit. Sales in this    visits a HIV/Aids voluntary counseling and testing center (VCT)      is generated through a carefully marketed strategy, which will       3.1 Four P’s
     sector are often fueled by rebranding campaigns that help to       or maternity clinic. In some cases, the client is asked to pay       benefit both sectors. We will explain in detail below.               Social marketing is best described according to the so-called
     attract consumers. Additionally, social marketing may prove to     a small amount for the female condom. Whether the female                                                                                  “Marketing Mix”, also known as the four P’s. A Marketing Mix
     be an effective way to further create demand by addressing a       condom is actually offered and available in the public sector        Social marketing is a marketing approach that is applied to the      strategy includes Product, Price, Place and Promotion strategies.
     common public health concern. Social marketing refers to the       varies from country to country. In many cases, the female            promotion of products that will promote a society’s well being       Technically, demand generation is a promotion strategy, yet
     use of marketing techniques to achieve behavioral goals that       condom does not receive equal attention and promotion                as a whole. This does not mean that it is strictly non-commercial.   its success is dependent on effective product, price and place
     benefit a society’s well being as a whole. In this sense, it may   when compared to the male condom and other contraceptive             Rather, it tends to use commercial marketing techniques to           strategies. Hence: understanding what your audience wants is of
     benefit both the public and the private sectors simultaneously.    methods. Furthermore, it tends to reach only a small proportion      achieve a non-commercial goal, e.g. the improvement of public        the utmost importance if you want to create demand effectively.
     While programming for large-scale female condom promotion,         of the population: those who visit public health centers for         health through behavioral change. Hence, its primary aim is          Developing a Marketing Mix strategy that includes all 4 P’s
     you will surely come across these different sectors and their      sexual and reproductive health matters, often women only.            the improvement of a social good. This is what makes social          ensures that you have considered all of the important questions
     subsequent approaches to creating demand and access.               B. Non-governmental organizations: International and                 marketing different from commercial marketing: the marketing         prior to designing your promotion strategy. This is illustrated
                                                                        national non-governmental organizations and community-               seeks to benefit the target audience and the society as a whole      below, with a focus on female condoms specifically.
                                                                        based organizations may provide education and counseling             without the explicit desire to make a profit. Social marketing
                                                                        with regard to how to use the female condom and they may             has been used extensively in international health programs,          Product/solution: In female condom programming the social
                                                                        distribute it. Often, a (international) donor or a United Nations    especially for contraceptives and oral rehydration therapy           marketing approach views the female condom as being the
                                                                        agency, such as UNFPA, has contracted these organizations            (ORT).                                                               solution for a range of sexual and reproductive health problems,
                                                                        to conduct female condom programming and to distribute                                                                                    such as unintended pregnancy and Sexually Transmitted
                                                                        the female condom for free. In many of these cases, female           Characteristics of a social marketing approach:                      Infections (STIs), including HIV/Aids. The target audience must
                                                                        condom programming is catering to specific groups only and not       • It offers a solution for a public (health) concern                 be convinced that the product offered is a good solution for a
                                                                        targeting the population at large.                                   • It focuses on behavioral change                                    public health concern.
                                                                                                                                             • It seeks to benefit individuals and the society as a whole
                                                                                                                                             • It is not about making a profit
                                                                        2.2 Commercial, for profit                                           • It creates demand for a certain product that will alleviate the
                                                                        A. Private sector: Players in the private sector sell the female       public concern, by way of an adapted marketing strategy               Did you know...
                                                                        condom for a profit. These may include shop owners, drug store       • It increases access to this product because it is being               Hair dressers themselves are models on the campaign
                                                                        owners, pharmacists, hotel owners, bar owners, barbers and             carefully marketed                                                    posters?
     Female condom demonstration in Nigeria                             hairdressers. They sell the female condom at a higher price          • It may offer the product at a subsidized price, although this
                                                                        than what they paid for it. These commercial sales may be              is not strictly necessary (depending on your assessment of
                                                                        supported by an attractive (re)branding campaign that attracts         price versus benefits)
                                                                        many customers to make the business profitable. In the case          • It applies a bottom-up approach by addressing the needs
        Did you know...                                                 of the male condom, this is a very common approach. When it            and desires of your target audience(s)
        ... That in Nigeria, the main users of the female               comes to the female condom however, the commercial approach
        condom are married women and men?                               is still underdeveloped. This can be explained by the fact that it
                                                                        is a fairly new product, still largely unknown by large groups of
                                                                        people, relatively expensive, and therefore not (yet) profitable.




70                                                                                                                                                                                                                                                                                    71
     The fact that the product offers a solution to health problems                                                     into their stock because of the small profit they will be able            female condom as a contraceptive method, how to use it, and                                              As for the commercial for-profit channel, stakeholders may
     alone does not guarantee that people will actually buy the                                                         to make when selling it. At the same time, constant advocacy              how to negotiate its use. Emphasis should be placed on sharing                                           assist in the normalization of the female condom when it is
     product. You should therefore make sure to develop a product                                                       efforts are needed towards the producers of female condoms                information about the female condom, because you want to                                                 increasingly available at day-to-day places like convenience
     strategy for people to become attracted to the female condom.                                                      for them to lower their prices in order to increase availability          increase the knowledge and skills of female condom users. The                                            stores, shops, bars, and supermarkets. The fact that the female
     Inherent to the product strategy should be the positioning of the                                                  and uptake at community level. 63                                         focus of promotion is on creating and sustaining demand for the                                          condom is not widely known as of yet, may cause the private
     product and the package design:                                                                                                                                                              product. Attractive branding campaigns, packaging and media                                              sector to be reluctant to invest in female condoms as it is
                                                                                                                                                                                                  involvement will contribute to this goal. In your promotion                                              primarily geared towards making a profit. When demand for the
     Positioning refers to how the target audience perceives                                                                                                                                      strategy, you will identify the target audiences, messages and                                           female condom is created through social marketing, people are
     the female condom. If, for example, women think of it as                                                                                                                                     channels of communication.                                                                               more likely to go to these day-to-day places to ask for and buy
     uncomfortable, you may decide to re-position the product                                                                                                                                                                                                                                              the female condom. Therefore, investing in the capacity building
     as pleasurable. When re-branding the female condom you                                                                                                                                       The 4 P’s can be complemented with another ‘P’: Package:                                                 of the private sector staff, demonstrating the market potential of
     should ask yourself: what makes this brand different from other                                                                                                                                                                                                                                       the product to them and making sure that they convey accurate
     brands, and how is it unique?                                                                                                                                                                Package design is related to the positioning of the product.                                             messages about the female condom when selling it is the way to
                                                                                                                                                                                                  Sales may increase because people are attracted to the                                                   go. This would be part of your “place” strategy.
                                                                                                                                                                                                  look, feel, sound, and smell of a product. Later on, in your
                                                                                                                                                                                                  promotional strategy, you will be able to use the concrete                                               It is important that there is continuous dialogue and
        Did you know...                                                                                                                                                                           aspects of your product strategy regarding the positioning and                                           collaboration between the different sectors. National
        ...That some female sex workers in Nigeria are paid                                                                                                                                       packaging of your female condom.64                                                                       government may be involved in the implementation of the
        more money because the men like it that they do                                                                                                                                                                                                                                                    socially marketed female condom. Vice versa, social marketing
        not feel the female condom (it feels more natural)                                                                                                                                                                                                                                                 organizations may help in building the capacity of government,
        (compared to the male condom)?                                                                                                                                                                                                                                                                     public sector staff, and private sector staff in promoting the
                                                                                                                        Taiya Ebijan in front of his cosmetic store in Lagos, Nigeria, where he      Did you know...                                                                                       female condom as a contraceptive method as mentioned above.
                                                                                                                        sells female condoms                                                         ...That hairdressing salons sell more female condoms                                                  Collaboration may also exist in procuring the female condom or
                                                                                                                                                                                                     than CBOs?                                                                                            in using each other’s distribution networks.
     Price/Value: Essentially, a female condom is more expensive                                                        Place/Access: Female condoms need to be at the right place at
     than a male condom due to the currently low overall production                                                     the right time, close to the day-to-day places that the (potential)                                                                                                                The different sectors complement each other in many ways and
     volume: there are simply fewer female condoms being                                                                user visits already for other purposes, to make sure that users                                                                                                                    social marketing can contribute to the overall strengthening of
     produced than male condoms. For many women and men, the                                                            have access to the product. It is important that both men and                                                                                                                      the sectors so that they are better equipped to create demand,
     price of a female condom forms an obstacle to buy and use it.                                                      women have the option of buying the female condom in a place              4. Complementarities and collaboration                                                                   increase access, and make the female condom available to as
     Social marketing of the female condom provides a subsidized                                                        that is both convenient and relatively private, so that they feel         Social marketing strategies may be aimed at both the public and                                          many people as possible. 65
     and high quality female condom, up to the level of what users                                                      comfortable buying it. Determining what would be appropriate              the private sectors in order to create demand for the female
     want to pay for it. A “willingness to pay survey” can help you                                                     places, requires you to assess your target audience’s habits:             condom. At the same time, when the public and private sectors
     to determine the price that would likely be acceptable to your                                                                                                                               are strengthened in providing the female condom, as well as
     target audience. In the case of the female condom, adapting                                                        • Where do they go regularly? What would be a safe                        the related education and counseling, access to the product                                                 Did you know...
     the price to make the female condom affordable will enable                                                           environment for them to be educated about the female                    will improve. Hence, the two different sectors—public and                                                   ...In the first two years of the female condom
     you to reach out to people who would never buy and use the                                                           condom?                                                                 private—need to be strengthened to create continued access to                                               programme in Nigeria, over 900,000 female condoms
     female condom when they perceive it as being expensive. In                                                         • Where do they want to have access to the female condom?                 the female condom for men, women and couples. The different                                                 were sold?
     other words: people may want to pay something if they are                                                          • Where do they think about or make choices that impact                   sectors will complement each other and you can find many ways
     convinced that the female condom benefits them. If the female                                                        their female condom use (e.g in a bedroom, pharmacy, bar,               to collaborate with both meaningfully.
     condom is too expensive, the price will outweigh the benefits of                                                     brothel) and how can you intervene appropriately at those                                                                                                                           Did you know...
     using it. The right price is about finding the appropriate balance                                                   moments of choice?                                                      In working with the non-commercial not-for-profit sectors,                                                  ...That between 2005 and 2009 care sales increased
     between cost and benefit. Price, however, is not only monetary:                                                                                                                              such as public health, it is helpful to invest in a dialogue with                                           by 135%?
     it can also be about time, effort, shame, and comfort. This is                                                     Place strategies also include methods of reaching the consumer:           the relevant public service stakeholders in order to map
     absolutely critical to any social marketing strategy, even more so                                                 from warehouses to outlets and peer educators. The staff and              existing difficulties regarding female condom promotion and
     for female condoms, where the intangible, non-monetary costs                                                       peer educators need training in creating demand and being                 distribution. This will help to jointly develop short-term and
     are often very high as people need to make a bigger effort to                                                      accessible, e.g. by extending the opening hours of outlets or by          long-term strategies to finding solutions for these problems.
     find the female condom and, even then, they may feel ashamed                                                       peer educators being highly mobile so that they may actively              Health personnel may not be trained adequately or does not
     to buy it.                                                                                                         approach the consumer.                                                    have the necessary demonstration and promotional tools.
                                                                                                                                                                                                  Therefore, it is important to consider the need to build the
     Not only will a subsidized female condom enhance sustained                                                         Promotion/Information: When promoting the female condom,                  capacity of health providers and other relevant public servants
     repeated use of the product by women and men, sellers of the                                                       peer educators use specifically designed communication tools              in this regard, as well as providing training sessions concerning
     product are also more willing to integrate the female condom                                                       to share information about sexual and reproductive health, the            promotion and the accurate and consistent use of the female
                                                                                                                                                                                                  condom.


                                                                                                                                                                                                    64   This is more elaborately discussed in the chapter 4: How to communicate with potential users
       63   Studies like the “willingness to pay” study can be integrated into other research activities described in this implementation guide.                                                    65   See Bibliography and Further Reading for more information on demand creation for female condoms




72                                                                                                                                                                                                                                                                                                                                                                              73
     Annex 1: Focus Group Discussion Guide for current
     users and non-users of the female condom66.
     FGD Guide for the Female Condom Mid-Evaluation.                                                                                                                                     6. Media listenership                                               This has been a very interesting discussion….
     Discussion relating to guide for current users of female condom                                                                                                                     Have you ever listened to any media campaign on the female
                                                                                                                                                                                         condom?                                                             Clarify unclear points, especially those that were made at the
                                                                                                                                                                                                                                                             beginning when the respondents may have felt uncomfortable.
                                                                                                                                                                                         Probe for:
     Warming up and explanation                                                                                    2. Profile of female condom user                                      • Radio/TV Station                                                  CLOSURE
                                                                                                                   Who do you think should use the female condom?                        • Message recollection                                              Those are all the questions I have for you today. The information
     Introduction                                                                                                                                                                        • How many times (estimated times) have they heard about the        you gave us has been very useful. Thank you very much for
     Welcome to [mention the venue] where we are going to discuss                                                  Probe for: detailed reasons in each case.                                campaign.                                                        participating in the survey and the interview.
     the use of the female condom. We are happy that you were                                                      • Ask for age group (18-29; 30-45) of female condom users.            • IPC shows
     able to spare some time to come and take part. Let’s begin by                                                 • Whether users are young or old.                                     • Meetings
     introducing ourselves. My name is…., my colleagues names                                                      • If it is considered old-fashioned or trendy.
     are…… We would like you to introduce yourselves too. Tell us                                                  • Users: Profession; working class, non-working class; traders.       7. Problems regarding the use of FC2
     your names or nicknames to be used during the discussion.                                                     • Poor, middle class or rich.
                                                                                                                   • Urban or rural use.                                                 Probe for:
     B. Purpose                                                                                                    • Literate or illiterate?                                             • Myths
     We will be discussing and sharing our opinions in relation to the                                                                                                                   • Misconceptions
     use of condoms to improve maternal and reproductive health.                                                                                                                         • If stigma is attached to use.
     We are interested in all your ideas, comments and suggestions                                                 3. Usability                                                          • Fear of spousal/partner disapproval
     on how best we can improve this product. All information will                                                 All of us here are users of FC2. What are the benefits of using the   • Male involvement/cooperation
     be treated as confidential.                                                                                   Elegance female condom?                                               • General suggestions and recommendations for
                                                                                                                                                                                            improvements.
     C. Explain the ground rules for discussion                                                                    Probe for:                                                            • Any other problems.
     This is a friendly discussion so there are no right or wrong                                                  • Comfort of use.
     answers. Everyone should feel free to express his/her opinion.                                                • If it is easy to carry in purse, bag, etc.
     We would like to have one speaker at a time with no side
     discussions during the session. Anyone can contribute to the                                                                                                                        FGD Guide for the Female Condom Mid-Evaluation.
     discussion at any time. You should feel free to agree or disagree                                             4. Accessibility                                                      Discussion Guide for Non-Users of the Female Condom
     with one another in a friendly manner. Refreshments will be                                                   Where do you buy or get female condoms?
     served after or halfway during the discussion.
                                                                                                                   Probe for:                                                            Warming up and explanation                                          with one another in a friendly manner. Refreshments will be
     Explain and seek permission to record the discussion.                                                         • Type of store/place; PPMV, private hospital/clinic,                                                                                     served after or halfway during the discussion.
                                                                                                                      government hospital, etc.                                          Introduction
     Ice breaker                                                                                                   • Estimated distance from house to place of purchase (in              Welcome to [mention the venue] where we are going to discuss        Explain and seek permission to record the discussion.
     What do we know about the female condom?                                                                         minutes).                                                          the female condom. We are happy that you were able to spare
                                                                                                                                                                                         some time to come and have this discussion. Let’s begin by          Ice breaker
                                                                                                                                                                                         introducing ourselves. My name is…., my colleagues names            What do we know about the female condom?
     1. Knowledge on the female condom                                                                             5. Affordability                                                      are…… We would like you to introduce yourselves. Tell us your
     What do you know about the female condom?                                                                     Do you think the female condom is affordable? Ask for detailed        names/nicknames to be used during the discussion.
                                                                                                                   reasons for either yes or no.                                                                                                             1. Knowledge on female condom
     Probe for:                                                                                                                                                                          B. Purpose                                                          What do you know about the female condom?
     • Name of the female condom they know.                                                                        Probe for:                                                            We will be discussing and sharing our opinions in relation to
     • What it looks like (description).                                                                           • Price.                                                              the use of condoms to improve maternal and reproductive             Probe for:
     • When it should be used.                                                                                     • Preferred price and reasons.                                        health. We are interested in all your ideas, comments and           • Name of the female condom they know.
     • How it is used (inserted).                                                                                                                                                        suggestions on what are the best ways to improve this product.      • What it looks like (description).
     • Who inserts it.                                                                                                                                                                   All information will be treated as confidential.                    • When it should be used.
     • Protection against STIs.                                                                                                                                                                                                                              • How it is used/inserted.
     • Protection against HIV.                                                                                                                                                           C. Explain the ground rules for the discussion                      • Who inserts it.
     • Protection against unwanted pregnancy.                                                                                                                                            This is a friendly discussion so there are no right or wrong        • Protection against STIs
     • How it is disposed of.                                                                                                                                                            answers. Everyone should feel free to express his/her opinion.      • Protection against HIV
                                                                                                                                                                                         We would like to have one speaker at a time and no side             • Protection against unwanted pregnancy
                                                                                                                                                                                         discussions during the session. Anyone can contribute to the        • How it is disposed of.
                                                                                                                                                                                         discussion at any time. You should feel free to agree or disagree


       66   From SFH 2011, How far have we gone and where do we go from here? Report of the Female Condom Mid-term Evaluation in the Edo, Delta and Lagos States of Nigeria.




74                                                                                                                                                                                                                                                                                                                               75
                                                                                                                                         Annex 2: Example of a Female Condom
                                                                                                                                         Program Goal and Objectives

     2. Profile of female condom user                                5. Affordability
     Who do you think should use the female condom?                  Do you think the female condom is affordable? Ask for detailed      Female Condom Program in Nigeria67
                                                                     reasons for either yes or no.
     Probe for: (ask for detailed reasons in each case)
     • Ask for age group (18-29; 30-45) of female condom users.      Probe for:                                                          Goals                                           • Reduction in the number of unwanted pregnancies.
     • Whether users are young or old.                               • Price.                                                                                                            • Reduction in the incidence of STIs and HIV infection.
     • If it is considered old-fashioned or trendy.                  • Preferred price and reasons.
     • Profession; working class, non-working class; traders.
     • Poor, middle class or rich?                                                                                                       Objectives                                      • Increase in the demand of the female condom.
     • Urban or rural use.                                           6. Media listenership                                                                                               • The female condom is publicly accepted as a commodity that enables women to exercise
     • Users literate or illiterate.                                 Have you ever listened to any media campaign on the female                                                            their sexual and reproductive rights.
                                                                     condom?                                                                                                             • Female condoms are widely available at convenient places, at all times and at an
                                                                                                                                                                                           affordable price.
     3. Usability                                                    Probe for:
     All of us here are non-users of FC2. What are the reasons why   • Radio/TV station
     we don’t use the female condom?                                 • Message recollection                                              Strategy: Project components                    •   Create enabling environments.
                                                                     • How many times (estimated times) have they heard about the                                                        •   Create demand.
     Probe for:                                                         campaign?                                                                                                        •   Inclusion of the female condom in existing programmes and service packages.
     • Myths                                                         • IPC shows                                                                                                         •   Managing the supply chain.
     • Misconceptions                                                • Meetings
     • If stigma is attached to use.
     • Fear of spousal/partner disapproval.                          This has been a very interesting discussion….
     • Male involvement/cooperation.
     • Not comfortable to use.                                       Clarify unclear points, especially those that were made at the
     • Not easy to carry in purse, bag, etc.                         beginning when the respondents may have felt uncomfortable.
     • Any other reasons.
                                                                     CLOSURE
                                                                     These are all the questions I have for you today. The information
     4. Accessibility                                                you gave us has been very useful. Thank you very much for
     Where can one buy or get female condoms?                        participating in the survey and the interview.

     Probe for:

     • Type of store/place; PPMV, private hospital/clinic,
       government hospital, etc.
     • Estimated distance from house to place of purchase (in
       minutes.)




                                                                                                                                         67   Society for Family Health Nigeria, 2008.




76                                                                                                                                                                                                                                                                                77
     Annex 3: Communication Strategy Outline                                                                                                           68
                                                                                                                                                                                                         Annex 4: Outline of an Advocacy Plan
                                                                                                                                                                                                         Name of advocacy action plan:
     Female Condom Promotion
                                                                                                                                                                                                         Issue:
     Audience                                     Communication                             Key Messages/                            Communication                             Activities
                                                  Objectives                                Themes                                   Channels                                                            Overall goal:


     Women and men of                             Increase the number                       Family Planning                          Inter-Personal                            • Branding: logo
     reproductive age                             of women and men                                                                   Communication                               and tagline that
                                                                                                                                                                                                          Objective(s):
                                                  having accurate                           HIV prevention                                                                       summarize female
                                                  knowledge of the                                                                   Sensitization                               condom and its
                                                  female condom.                            Reliability                                                                          benefits.
                                                                                                                                     Road shows/drama
                                                  Increase the number                       Empowerment                                                                        • Peer education
                                                  of women and men                                                                   Branding campaign
                                                  buying the female                         Health                                                                             • T-shirts/promo items
                                                  condom.                                                                            Mass media                                  with brand
                                                                                            Pleasure                                                                                                      Target audience:
                                                                                                                                                                               • Billboards

                                                                                                                                                                               • Road shows/drama
                                                                                                                                                                               • National TV
                                                                                                                                                                                 advertisements           Support Groups:

                                                                                                                                                                               • Female condom
                                                                                                                                                                                 champion


     Hairdressers                                 Increase the number                       Family Planning                          Inter-personal                            • Branding: logo
                                                  of hairdressers                                                                    communication                               and tagline that         Message and channels of communication:   Resources needed:
                                                  who have accurate                         HIV prevention                                                                       summarizes female
                                                  knowledge of the                                                                   Visits                                      condom and its
                                                  benefits of the                           Health                                                                               benefits.
                                                  female condom.                                                                     Mass media
                                                                                            Reliable                                                                           • Posters, flip charts,
                                                  Increase the number                                                                Training                                    T-shirts
                                                  of hairdressers who                       Empowerment
                                                  become peer                                                                                                                  • Training                 Activities + Time and place:
                                                  educators and sales                       Profit
                                                  agents.                                                                                                                      • Toolkit with female
                                                                                                                                                                                 condom messages
                                                                                                                                                                                 for use during
                                                                                                                                                                                 counseling.


     Young people                                 etc. ………                                  ………                                      ………                                       ………
                                                                                                                                                                                                          Agreements on follow up:                 Strategy: Project components

     Media                                        ………                                       ………                                      ………                                       ………


     Health care workers                          ………                                       ………                                      ………                                       ………


     Other




     68   Please note that this is a simple example of a communications plan. This is based on Zimbabwe Ministry of Health, National Communications Strategy for Male Circumcision.




78                                                                                                                                                                                                                                                                                79
     Abbreviations                                                            Bibliography and further reading
     AIDS       Acquired Immune Deficiency Syndrome                           1. Bibliography
     ACMS       Association Camerounaise pour le Marketing Social
     CBO        Community Based Organization                                  Center for Health and Gender Equity. Female Condoms and U.S. Foreign Assistance: An Unfinished Imperative for Women’s Health.
     cm         Centimeter                                                    Washington, DC: Center for Health and Gender Equity, 2011
     CSO        Civil Society Organization
     DJ         Disk Jockey                                                   Fontanet AL, Saba J, Chandelying V, et al. Protection against sexually transmitted diseases by granting sex workers in Thailand. the choice
     FAQ        Frequently Asked Questions                                    of using the male or female condom: results from a randomized controlled trial. AIDS 1998;12(14):1851–59.
     FBO        Faith Based Organizations
     FC         Female Condom                                                 Gollub EL. The female condom: tool for women’s empowerment. American Journal of Public Health 2000;90(9):1377–81.
     FC2        Female Condom 2                                               Policy Project (1999): Networking for
     FDA        (US) Food and Drug Administration
     FEFO       First Expired First Out                                       Policy Change: An Advocacy Training Manual
     FGD        Focus Group Discussion                                        http://www.policyproject.com/pubs/AdvocacyManual.cfm
     FP         Family Planning
     GPI        Girls’ Power Initiative                                       IPPF (2009) Generating Political Change, using advocacy to create political commitment.
     HIV        Human Immunodeficiency Virus                                  http://www.ippf.org/en/Resources/Guides-toolkits/Generating+political+change.htm
     IEC        Information, Education, Communication
     IPC        Inter-Personal Communication                                  MenEngage Global Alliance: http://menengage.org/.
     KAB/P      Knowledge, Attitude, Behavior/Practices
     LAPO       Lift Above Poverty Organization                               UNAIDS (2010), Report on the Global Aids Epidemic. http://www.unaids.org/globalreport/
     M&E        Monitor and Evaluation
     MDGs       Millennium Development Goals
     MICS       Multiple Indicator Cluster Surveys                            2. Further reading on female condom programming
     MINIMIDT   Minister of Industries, Mines and Technological Development
     MINPROFF   Minister of Woman Empowerment and the Family                  This guide for planning and programming in relation to the female condom is intended to help design, implement, and monitor the
     MoU        Memorandum of Understanding                                   introduction of the female condom in different settings. It is developed by UNAIDS and the WHO:
     N.B.       Nota bene                                                     http://data.unaids.org/publications/IRC-pub01/jc301-femcondguide_en.pdf
     NGOs       Non-Governmental Organizations
     ORT        Oral Rehydration Therapy                                      This guide of UNFPA contains a 10-step strategic approach to scale up culturally appropriate and effective efforts towards
     PLHIV      People Living with HIV                                        comprehensive condom programming:
     PMTCT      Preventing Mother To Child Transmission (of HIV)              http://unfpa.org/webdav/site/global/shared/documents/publications/2011/CCP.pdf
     PSI        Population Services International
     PSM        Procurement and Supply chain Management                       On this UNFPA website you can find useful information, facts and publications about comprehensive condom programming with regards
     SFH        Society for Family Health                                     to HIV/AIDS prevention:
     SMS        Short Message Service                                         http://www.unfpa.org/hiv/programming.htm
     SRH        Sexual and Reproductive Health
     SRHR       Sexual and Reproductive Health and Rights                     UNFPA, FHI and the Inter Agency Task Team on condoms. Creating demand for male and female condom use (forthcoming, planned for
     STI        Sexually Transmitted Infections                               fall/ winter 2011; title might still change)’.
     SWAA       Society for Women and AIDS in Africa
     ToT        Training of Trainers                                          Conducting a Situational Analysis
     ToR        Terms of Reference                                            Chapter Process
     UAFC       Universal Access to Female Condoms (Joint Programme)
     UN         United Nations                                                This tool on situation analysis is useful when examining the availability and quality of family planning and reproductive health services
     UNFPA      United Nations Population Fund                                in a large area, e.g. a country, or in a smaller area, e.g. a region or city:
     VCT        Voluntary Counseling and Testing                              http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/srh_guide/tools_situationanalysis.html
     WHO        World Health Organization
                                                                              This document helps to monitor progress towards the goal of universal access to sexual and reproductive health at country level by
                                                                              presenting a set of indicators within a clearly specified framework:
                                                                              http://whqlibdoc.who.int/hq/2010/who_rhr_10.12_eng.pdf

                                                                              This tool aims to provide a guide for assessing linkages that can be adapted as needed to regional or
                                                                              national contexts based on a number of factors. It can also contribute to the development of action-plans to strengthen SRH and HIV
                                                                              linkages. It is available in five languages:
                                                                              http://www.ippf.org/en/Resources/Guides-toolkits/Rapid+Assessment+Tool+for+Sexual+Reproductive+Health+and+HIV+Linkages.htm




80                                                                                                                                                                                                                          81
     Baseline studies                                                                                                                              Communication Strategies
     Chapter 1: Process                                                                                                                            Chapter 4: How to communicate with potential users

     MICS is a tool for collecting and analyzing data. It is used to fill data gaps for monitoring the situation of children and women by way of   This matrix made by CARIMAC and the University of the West Indies can be of use when comparing types of media. It shows the
     an international household survey. http://www.unicef.org/statistics/index_24302.html                                                          advantages and disadvantages as well as cost estimates of many types of media:
                                                                                                                                                   http://63.175.159.26/~cimh/cami/files/PUBCOMM/PresK11/PDF/Media%20Matrix.2.pdf

     Monitoring and Evaluation (M&E)                                                                                                               This chapter, written by UNESCO, (S. Ganguly), describes different ways to communicate through media, different communication
     Chapter 1: Process                                                                                                                            systems and several communication strategies:
                                                                                                                                                   http://www.unesco.org/education/aladin/paldin/pdf/course02/unit_13.pdf
     A comprehensive handbook on monitoring, evaluation and learning, including a tool to assess capacity: http://www.ippf.org/NR/
     rdonlyres/F82E6BEC-6DF6-4B8A-B7BB-0FC748999F69/0/IPPFMonitoringEvaluationHandbook.pdf
                                                                                                                                                   Advocacy
                                                                                                                                                   Chapter 6: Advocacy towards decision makers
     Peer Education
     Chapter 4: How to communicate with potential users                                                                                            This toolkit contains a step-by-step approach, leading you through the advocacy process. It gives concrete action points and checklists to
                                                                                                                                                   help you to carry out your advocacy work most effectively:
     This framework provides an IPPF perspective on peer education and is meant to assist in ensuring peer education programmes are as             http://www.ippf.org/NR/rdonlyres/E4ED7799-7C00-40C2-9B0C-81C660C9CCE6/0/From_advocacy_to_access.pdf
     effective as possible. It is available in English, French and Spanish:
     http://www.ippf.org/en/Resources/Guides-toolkits/Peer+Education+Framework.htm                                                                 This handbook uses case studies to describe how to advocate for sexual and reproductive health and rights:
                                                                                                                                                   http://www.ippf.org/NR/rdonlyres/01B9F6ED-CE97-40B5-ABFB-9B83A0B23A93/0/GeneratingPoliticalChange.pdf

     IEC material                                                                                                                                  This training manual is very useful for advocacy planning. Policy Project (1999): Networking for Policy Change: An Advocacy Training
     Chapter 4: How to communicate with potential users                                                                                            Manual: http://www.policyproject.com/pubs/AdvocacyManual.cfm

     This IPPF checklist helps to create effective Information, Education and Communication (IEC) materials for young people with regard to        This Change Agency tool is helpful in explaining how to asses, step by step, the social and political context within which a campaigning
     SRHR. It includes a list of elements which should (or should not) be used in developing IEC materials:                                        strategy is developed, creatively considering allies, opponents, targets and constituents:
     http://www.ippf.org/NR/rdonlyres/DFB5E407-57B0-4381-BC37-432497BCE386/0/YouthMessagingChecklist.pdf                                           http://www.thechangeagency.org/_dbase_upl/tCA_power_mapping.pdf


     Social Marketing
     Chapter 8: Creating demand, increasing access

     www.social-marketing.com




82                                                                                                                                                                                                                                                                                              83
     Frequently Asked Questions
     Female Condom Promotion                                             •	 think that their partners prefer the female condom because              Can the female condom add pleasure during sex?               female condom during sexual intercourse. Fears that the female
                                                                            it can give them greater pleasure.                                                                                                   condom might enter the womb/cervix, are, however, totally
             Why should the female condom be universally                 •	 For men the sensation is closer to that of sex without a        Yes, the pleasure one experiences depends on the type of             unjustified. Both the outer and the inner rings and the sponge(s)
             accessible?                                                    condom, because female condoms do not fit tightly around        female condom used and on your personal preferences. Since           prevent this from happening.
                                                                            the penis as male condoms do.                                   all female condoms offer dual protection, one can relax and
     The female condom offers women and men dual protection.             •	 Many users believe that female condoms are stronger and         one does not need to worry about becoming pregnant or getting
     The female condom protects against all sexually-transmitted            thus safer than male condoms, which helps them to relax and     a sexually transmitted infection such as HIV while having sex.                Where can you buy female condoms?
     infections (also on the outside of the vagina) including HIV.          enjoy sex.                                                      Some couples have found that the inner and outer ring of the
     Furthermore, it prevents pregnancy. 215 million women in            •	 Although female condoms were not designed for anal sex,         FC2 adds pleasure to the sexual experience; the same goes for        This differs per country. In some countries, the female
     developing countries would like to use contraception but have          some couples prefer them to male condoms when having            the outer ring of the Reddy and Cupid condoms. Some men              condom can be bought in pharmacies, commercial outlets,
     no access to it.                                                       anal sex.                                                       prefer the female condom to the male condom because it does          at hairdressers, etc. Sometimes the female condom is also
                                                                                                                                            not fit tightly around the penis. Also the sponge in the Reddy       distributed in the public sector. Unfortunately, there are often
     The female condom contributes to meeting international              Note that a female condom and a male condom should not be          condom can add pleasure for the man. Since the material used         stock-outs making it difficult to obtain condoms.
     commitments on development. The Millennium Development              used at the same time!                                             to make the FC2 is not latex but nitrile, it conducts heat, which
     Goals (MDG’s) on maternal and child mortality and morbidity                                                                            can make sexual intercourse feel very sensitive and natural.
     rates, as well as HIV/AIDS will not be attained if existing                                                                                                                                                          Which models of female condoms are available?
     technologies, such as the female condom, remain out of reach                Why is the female condom relatively expensive?
     for those women who need it.                                                                                                                   Who would you recommend should use the female                At the moment, the FC2, the VA w.o.w.® female condom (also
                                                                         There are three main reasons for the current price level of the            condom?                                                      known as: Reddy/V’Amour/L’amour), and the Cupid ltd. Latex
     Gender inequality is an important driver of the HIV epidemic;       female condom:                                                                                                                          Female Condom are available. Not all three varieties are yet
     the feminisation of AIDS has become a reality. Women make                                                                              The female condom is suitable for all women and men. For             available in all countries.
     up more than half of the 33 million people worldwide currently      Use of Materials                                                   some couples, it is a huge advantage that it can be inserted even
     infected with HIV. In Sub-Saharan Africa, 76% of HIV-positive       More materials are needed for the production of the female         before foreplay (and not in the ‘heat of the moment’). Just like
     youth are female. Women and girls face the consequences of          condom (compared to that of the male condom). Furthermore,         the male condom, you need to practice using it. Therefore, we
     unprotected sex and bear a huge burden through unwanted             the material itself can be more expensive. The FC2, for example,   advise you to try it several times and then judge whether the
     pregnancy and the risk of infection. The female condom is the       is made of nitrile, which is more expensive than latex. The        female condom works for you.
     only device that offers dual protection, is women-initiated and     packaging and the placing of rings and/or the sponge make the      It can be used:
     is available now. Universal access to female condoms should         production process more complicated and labour-intensive           With other contraceptives including the pill and intra-uterine
     therefore be a priority.                                            and thus more expensive. More research and development is          devices
                                                                         needed to work towards cheaper female condom types.                During menstruation
                                                                                                                                            After having recently given birth                                       FC2 Female Condom
             What is the advantage of the female condom over             Economies of scale                                                 During menopause
             the male condom?                                            Female condoms are not produced on a very large scale.                                                                                     •	   Made of Nitrile, a synthetic latex.
                                                                         Because relatively few female condoms are produced, their                                                                                  •	   Conducts heat.
     Female condoms offer more flexibility regarding the timing of       price is higher. For example, roughly 423 male condoms                     Does the female condom make noise?                              •	   Has two rings to keep it in place.
     insertion and removal. The condom can be inserted prior to          are produced for every female condom. If more large-scale                                                                                  •	   Lubricant included
     intercourse and even before foreplay (the length of time before     female condom programs were to be implemented and the              None of the female condoms are noisy. FC1 (the first FC model           •	   Since it is made of synthetic material, it is also suitable
     intercourse and foreplay depending on the type of female            procurement and production of female condoms were to               produced by the Female Health Company) was made of rather                    for people with a latex allergy. It is also not affected by
     condom. However, latex is weaker and deteriorates faster.           increase, the price would decrease.                                thick polyurethane and was known for the “crispy” sound.                     temperature and humidity so it can be stored almost
     Insertion should, therefore, not take place too long before sex),                                                                      The FC1 has, however, been replaced by the FC2 (the newer FC                 anywhere.
     compared to the male condom which needs to be put on just           Dominant position of one manufacturer                              model of the Female Health Company) almost anywhere. The
     before intercourse, “in the heat of the moment”, so to speak.       The FC2 is produced by the manufacturer Female Health              FC2 is made of nitrile, which is a synthetic latex that feels very
     Female condoms (compared to the male condom) give women             Company. This condom is the only one on the market with            natural. It adapts to body temperature. The Dr. Reddy and Cupid
     more power to negotiate safer sex and a greater sense of control    World Health Organisation (WHO) certification. Other               condoms are made from latex, which is not noisy. The PATH
     and safety. Many women find them easier to use because they:        manufacturers have not yet fulfilled all the requirements of       Women’s condom is made of such thin polyurethane that you
     •	 can initiate their use;                                          the WHO certification procedure. This means that only FC2 is       can hardly hear it.
     •	 have greater ownership of the female condom, since they          purchased by donor agencies and international organisations
        can insert it themselves, even before foreplay;                  which enables the Female Health Company to dominate
     •	 do not require the same degree of co-operation from their        the market and keep the price artificially high. Introducing               How do you insert and remove the female condom?
        partners, since the latter do not need to put it on;             competition into the female condom market would help to lower                                                                              Reddy Female Condom
     •	 do not have to repeatedly negotiate use, as with the male        unit prices. Therefore, it is important that more condoms are      The way to insert and remove the female condom after sexual
        condom, particularly at the moment when it must be               prequalified (certified) by the WHO.                               intercourse depends on the type of female condom you are                •	 Made of latex (rubber).
        inserted;                                                                                                                           using. In general, any female condom is not difficult to use            •	 Has one triangular ring and
     •	 think that their partners prefer to transfer responsibility to                                                                      although it does require some practice. It is recommended                  one sponge to keep it in place.
        them;                                                                                                                               that first-time users review the detailed instructions, and take        •	 Lubricant included.
                                                                                                                                            time to practice insertion and removal before actually using a




84                                                                                                                                                                                                                                                                                     85
                                                                                                                                               Glossary
                                                                                 Why is it important that there are different types of         Please see below explanations of terms used in the context of      Lead organization
                                                                                 female condoms on the market?                                 this guide.                                                        The lead organization is part of the operational team and
                                                                                                                                                                                                                  coordinates the program. It may have regional teams or
                        Cupid Female Condom                              There are two reasons why there should be different types                                                                                offices for overseeing regional activities. It is responsible for
                                                                         of female condoms on the market. First, people differ and             Advocacy                                                           the operational design, implementation and monitoring of
                        •	 Made of latex (rubber).                       preferences differ. Therefore, it is important that people can        Advocacy is a process to get support, promotion and funds for      program activities vis-à-vis the donor(s). Financial and narrative
                        •	 Has one octagonal ring and one                choose a condom that fits their preferences as best as possible.      the female condom by influencing different decision makers,        reporting is also the responsibility of the lead organization. It
                           sponge to keep it in place.                   If there is only one female condom on the market, and a person        such as community leaders and other gatekeepers, government        coordinates and communicates with several partners, from the
                        •	 Lubricant included.                           does not like using that particular type, it is important to offer    and institutions. A positive attitude towards the female condom    supervisory body, to CBOs and peer educators.
                                                                         an alternative.                                                       and its benefits therefore needs constant sensitization and
                                                                                                                                               engagement of influential leaders in the community.
                                                                         Second, different types of female condoms can lead to lower                                                                              Large-scale female condom programming
                                                                         prices. Currently the FC2 female condom is the only condom                                                                               Large-scale female condom programming reaches out to the
                                                                         widely available because it is the only female condom                 Civil Society Implementing Partners                                entire (sexually active) population in providing a choice in
                                                                         approved by the World Health Organisation. This is needed             Civil society implementing partners include e.g. community-        family planning and contraceptive methods. This programming
             Which developments in the field of female condoms           as a prerequisite for UN organisations, the most important            based and faith-based organizations, female condom peer            aims to make the female condom available, affordable and
             are foreseen in the future?                                 distributor of female condoms. If other condoms are tested and        promoters, women, men and youth group leaders who have             accessible for all.
                                                                         approved by the World Health Organisation, there will be more         close connections with a community and its gatekeepers and
     The Dr. Reddy condom and the Cupid condom have been                 competition between the manufacturers of condoms. More                consequently can gain easy access to target groups and create
     approved by the European Commission, but not yet by the             competition will lead to lower prices of female condoms and           acceptability of the product.                                      Lead trainers
     World Health Organisation. If advocating for the testing of         thus wider availability.                                                                                                                 Lead trainers disseminate their knowledge to peer educators,
     these condoms at national Food and Drug Administrations or at                                                                                                                                                and support them in their activities in the communities.
     the World Health Organisation is successful, they will become                                                                             Community leaders                                                  Lead trainers take part in a Training of Trainers by the lead
     much more widely available than they are today. Currently, the              What kind of lubricant can be used with the female            Community leaders are local government leaders and religious       organization. These lead trainers may belong to organizations
     Woman’s Condom, developed by a global health non-profit                     condom?                                                       leaders.                                                           that have a wide reach in reproductive health, family planning
     organisation, PATH, is going through the required process for its                                                                                                                                            and HIV interventions. They can also be strong influential
     introduction on the market.                                         The FC2, Dr. Reddy and Cupid condom come pre-lubricated. It                                                                              individuals in a community who support the project.
                                                                         is of course possible to use extra lubrication on the inside of       Commercial (profit) sector:
                                                                         the female condom or on the penis. With the FC2 you can use           Commercial (profit) players may include shop and drug-store
                                                                         water-based silicone as well as oil-based lubricants. With the        owners, pharmacists, hotel and bar owners and barbers and          Peer educators
                                                                         Dr. Reddy and Cupid condoms you can only use water-based              hair stylists who sell the female condom for a profit. They        Peer educators play a role in educating their “peers” in female
                                                                         lubricants or silicone lubricant, not oil-based lubricants. This is   sell it for the wholesale price plus a margin. This commercial     condom use. Education about the female condom requires
                        Woman´s Condom                                   because if you use oil-based lubricants with latex condoms they       approach is still underdeveloped in relation to the female         a safe environment and a delicate approach to (potential)
                                                                         may tear. If you want to keep it simple, only recommend the use       condom. The reason is that the female condom is a fairly new       users. The target group needs to feel safe and comfortable in
                        •	 Made	of	very	thin	polyurethane.               of water-based and silicone lubricants with female condoms.           product, largely unknown, expensive and therefore not (yet)        raising questions and concerns about female condom use. Peer
                        •	 Can	be	inserted	like	a	tampon.                                                                                      profitable.                                                        educators are vital in female condom education and counseling.
                        •	 The	little	cap	will	dissolve		within	                                                                                                                                                  They may include CBO staff, hairdressers and barbers, or
                           minutes when in contact with any                                                                                                                                                       people living in communities you are able to target because
                           liquid (e.g. bodily fluid or lubricant).                                                                            Drug stores                                                        the were identified by the lead organization’s technical staff.
                                                                                                                                               Drug stores are often small merchandise kiosks where they also     They are trained and equipped with educational tools, female
                                                                                                                                               sell some non-prescription health items.                           condoms and possibly a demonstration model.



                                                                                                                                               Gatekeepers                                                        Public sector
                                                                                                                                               Gatekeepers are opinion leaders like chiefs, traditional rulers,   Public sector partners include, for example, health and family
                        Woman´s Condom                                                                                                         and other influential people.                                      planning clinics, (community) health workers, infections clinics,
                                                                                                                                                                                                                  support groups for People Living with HIV, antenatal, PMTCT
                        •	 The	condom	will	unfold	automatically	                                                                                                                                                  and postnatal clinics and testing and counseling centers.
                           on penetration.                                                                                                     Inter-personal communication
                        •	 Little	sponges	on	the	side	keep	                                                                                    IPC is a face-to-face method that takes place between the
                           the condom in place.                                                                                                educator and the potential user in which there is inter-personal   Private sector
                        •	 Lubricant	is	included	in	a	separate	                                                                                dialogue about the female condom, and opportunity for the          Private sector partners include, for example, hairdressers and
                           sachet in order to protect the cap.                                                                                 user to voice concerns and ask questions.                          barbers, pharmacies and drug stores, sex worker networks,
                                                                                                                                                                                                                  manicurists, hotel owners, private clinics, organizations
                                                                                                                                                                                                                  employing numerous men and women and various female-
                                                                                                                                                                                                                  oriented sales points.




86                                                                                                                                                                                                                                                                                     87
                                                                                                                                           Acknowledgements
     Procurement and Supply chain Management (PSM)                       Social Marketing                                                  This publication was produced by the Universal Access to           Administrative support was provided by Nelleke Buijs, Sabine
     Procurement and Supply chain Management is the process              Social marketing is a marketing approach that is applied to the   Female Condoms (UAFC) Joint Programme. It was written by           Knopper and Kathy de Kruijf of Rutgers WPF.
     of purchasing, in this case female condoms, from the                promotion of products that promote a society’s wellbeing as       Hilde Kroes of Rutgers WPF, edited by Steffie Verstappen and
     manufacturer, shipping them to a particular country, storing        a whole. It tends to use commercial marketing techniques to       translated into French by Roger Issa Coulibaly. The layout of      We are thankful for the contributions, suggestions and other
     them in warehouses and depots, and organizing the logistics to      achieve a non-commercial goal, e.g. the improvement of public     this publication was designed by Dox Imagemakers, under the        feedback of third parties:
     get the female condoms to outlets, CBOs, public-health centers      health through behavioral change.                                 supervision of Annet Neijmeijer (Rutgers WPF).                     • Louise Lee-Jones – Marie Stopes International (MSI)
     and peer educators. The overall goal of PSM is to make sure that                                                                                                                                         • Beth Skorochod – Population Services International (PSI)
     the product is moving continuously, i.e. that all segments of the                                                                     The UAFC Joint Programme could not have realized the               • Sarah Shaw – International Planned Parenthood Federation
     supply chain are continuously stocked.                              Supervisory body                                                  publication without the extensive contributions from Society          (IPPF)
                                                                         The operational team can be supported by a supervisory            of Family Health (SFH) Nigeria, Association Camerounaise pour      • Dieneke ter Huurne, David Smith, Doortje Braeken, Ilka
                                                                         body that oversees program implementation. The supervisory        le Marketing Social (ACMS), PSI Zimbabwe, PSI Mozambique              Rondinelli, Jennifer Woodside, Jolene Innis, and Sarah Shaw
     Re-branding                                                         body not only advises on how to maximize impact of the            and Girls’ Power Initiative (GPI) Nigeria, and in particular the      - International Planned Parenthood Federation (IPPF)
     The FC2, for example, is branded as the FC2 by the Female           implementation, it also has a strong advocacy component:          following individuals who formed the Reading Committee:            • Frederica Stines and Audacia Ray – International Women’s
     Health Company. You can choose to rebrand the FC2 to fit            members represent certain groups in society and have strong       • Dorien Rhebergen – PSI Mozambique                                   Health Coalition
     in with the local context and target audiences. In Nigeria,         networks. Especially with regard to the promotion of the female   • Ifeoma Ideh – Society for Family Health Nigeria
     Cameroon and Zimbabwe for example, only FC2s are sold,              condom, such ‘champions’ acting as part of the governance         • Lily Claire Ekobika – Association Camerounaise pour le           In Cameroon for pre-testing this publication:
     but they are rebranded as “Elegance”, “Protectiv” and “care”        structure are important for the execution and sustainability of       Marketing Social (ACMS)                                        • Community Initiative for Sustainable Development
     respectively.                                                       the project.                                                      • Lucie van Mens – UAFC Joint Programme Coordinator                    (COMINSUD)
                                                                                                                                           • Patience Kunaka – PSI Zimbabwe                                   • BALI Treatment Centre
                                                                                                                                           • May Ikoghode – Girls’ Power Initiative Nigeria                   • Mey-low-D Foundation for Youth Edutainment
     Sensitization sessions                                                                                                                • Michèle Razanamparany – i+ solutions                             • OVERCOMERS
     Sensitization sessions are group sessions, in which a peer                                                                            • Nienke Blauw – Rutgers WPF                                       • Youth Outreach Program (YOP)
     educator addresses groups of people for example in the                                                                                Many thanks to you all for your time, energy and inspiration.
     market, in hospitals or during workshops or meetings. Group                                                                                                                                              The activities described in this publication would not have been
     sensitization sessions can be carried out in mixed female                                                                             Other individuals contributed at different occasions throughout    possible without the support of our donors and partners:
     and male groups, but also in separate groups. This strategy                                                                           the documentation and writing process:
     creates interest in the product and is an effective method to                                                                         • Victoria Archibong, Ifeanyi Okekearu and Mimi Sharon Ede         The Hewlett Foundation
     inform larger groups of people. The disadvantage is that the                                                                             of SFH;                                                         Netherlands Ministry of Foreign Affairs
     environment does not allow personal questions or concerns                                                                             • Heyndricks Bile, Annie-Michèle Salla and Hervé Roger             Danish Ministry of Foreign Affairs (DANIDA)
     to be raised. The peer educator, who has been trained in                                                                                 Ngueche of ACMS                                                 Norwegian Ministry of Foreign Affairs (NORAD)
     counseling, is available afterwards to address these personal                                                                         • Gertjan van Bruchem and Monique Demenint of Oxfam                Swedish Ministry of Foreign Affairs (SIDA)
     issues.                                                                                                                                  Novib                                                           Oxfam Novib
                                                                                                                                           • Yvonne Bogaarts, Sille Jansen and Margo Bakker of Rutgers        United Nations Population Fund (UNFPA)
                                                                                                                                              WPF
                                                                                                                                           • Jennifer Oboh - LAPO
                                                                                                                                           • Maira Solange Hari Domingos – Fórum Mulher Mozambique;
                                                                                                                                           • Margarida Guerra, Pathfinder International Mozambique
                                                                                                                                           • Cobi Mars
                                                                                                                                           • Sonny Onwuche Akoh
                                                                                                                                           We are very grateful for your extensive contributions.




88                                                                                                                                                                                                                                                                               89
     Colophon
     The Implementation Guide on Female Condom Programming             does capacity building of technical health care personnel and      Girls Power Initiative (GPI)                                          Rutgers WPF
     is based on the experiences of large- scale female condom         community outreach; and PSI/Mozambique is strong in supply         Girls Power Initiative (GPI) is an NGO located in four states of      Rutgers WPF is a renowned expert centre on sexual and
     programmes in four different countries: Cameroon,                 chain management and social marketing. All organisations are       Nigeria focussing on empowering adolescent girls for social           reproductive health and rights. Its activities are mainly carried
     Mozambique, Nigeria and Zimbabwe. The programmes in               actively engaged in Interpersonal Communication (IPC) to create    action through skills training relating to sexuality, human rights,   out in the Netherlands, Africa and Asia. Its aim is to improve
     Cameroon and Nigeria are part of the Universal Access to Female   demand and to familiarize people with the consistent use of        life management and leadership from a gender perspective,             sexual and reproductive health and rights throughout the world,
     Condoms (UAFC) Joint Programme whereas the programmes             female condoms.                                                    in this way promoting and protecting their sexual and                 specifically focussing on young people, women and vulnerable
     in Mozambique and Zimbabwe are stand-alone programmes.            The Consortium works in conjunction with the national Council      reproductive health and rights.                                       groups like the disabled or chronically ill. Rutgers WPF
     Please find a brief description of each programme below:          of HIV and the Ministry of Health on various fronts, including     http://www.gpinigeria.org/                                            supports partner organisations and professionals in their work,
                                                                       the approval of all IEC material.                                                                                                        increasing their expertise on sexuality.
                                                                       http://www.psi.org/mozambique                                                                                                            Rutgers WPF evolved from the merger of the Rutgers Nisso
     Care Initiative (PSI/Zimbabwe Female Condom Programme)                                                                               Population Services International (PSI) Mozambique                    Groep, Dutch expert centre on sexuality, and the World
     The care female condom programme is an innovative initiative                                                                         Population Services International (PSI) is an international           Population Foundation (WPF). This merger took place at the
     focused on interpersonal communication (IPC) between women        Universal Access to Female Condoms (UAFC) Joint                    NGO with headquarters based in the USA. PSI/Mozambique                end of 2010. Rutgers WPF is a member of IPPF, the International
     and their hair stylist, sex worker queens and their peers and     Programme                                                          has been operating in Mozambique since 1994. The                      Planned Parenthood Federation.
     women living in positive or discordant relationships. The         The UAFC Joint Programme started in 2008 with the aim of           organisation, supported by the Ministry of Health, is engaged         www.rutgerswpf.org
     programme was launched in 1997. Currently the initiative          making female condoms accessible, affordable and available         in the promotion of healthy behaviour amongst vulnerable
     involves working with over 1,500 hairdressers, over 100 sex       for all. Thus it would contribute to a decrease in new HIV         populations. PSI works in the area of reproductive health, HIV/
     worker groups and more than 50 People Living with HIV (PLHIV)     infections, STIs and mistimed and unwanted pregnancies and         AIDS, Malaria, Safe Water Systems and Nutrition.                      Society for Family Health (SFH)
     support groups.                                                   enable women to exercise power over their own sexual and           http://www.psi.org/mozambique                                         The Society for Family Health (SFH), based in Nigeria, is a
                                                                       reproductive health.                                                                                                                     foremost indigenous non-governmental organisation founded
     At a national level, PSI Zimbabwe trains hairstylists, sex                                                                                                                                                 in 1985. SFH is dedicated to empowering Nigerians, particularly
     worker queens and women living positively to discuss the          The programme is an initiative of Oxfam Novib, Rutgers WPF, i+     Population Services International (PSI) Zimbabwe                      the poor and vulnerable to lead healthier lives. SFH supports
     brand attributes of the female condom. Training also covers       solutions, and the Netherlands Ministry of Foreign Affairs and     PSI/Zimbabwe was established in 1996 to reduce the rate of HIV        public health intervention efforts of the Federal Government
     the benefits of using the female condom with demonstrations       consists of three components:                                      infections in Zimbabwe, prevent malaria and improve family            of Nigeria, with specialisation in three key public areas
     on how to use it correctly. The programme targets areas of        1. Research and Development, including procurement,                planning practices using social marketing strategies. Between         including HIV&AIDS prevention, Child Spacing and Maternal
     high-risk activity such as Growth Points and border towns         2. Large-scale female condom country programmes in Nigeria         2008 and 2009, the programme added hygiene promotion and              and Child Health (malaria and diarrhoea control). It deploys
     and aims to open channels and train community outreach               and Cameroon, implemented by the Society for Family             home-based water treatment and male circumcision services to          social marketing techniques through health communication,
     agents. Community outreach activities are complimented by            Health (SFH) and ACMS respectively, in cooperation with         its portfolio. PSI works in close partnership with the Zimbabwe       advocacy, research, community mobilisation, product sales and
     mass media campaigns to help normalize the female condom,            other civil society organisations, the government, UN           Ministry of Health and Child Welfare and other stakeholders           distribution which are carried out by over 350 employees in 16
     minimize stigma and generate partner support for the product.        agencies and the private sector and supervised by a national    in order to reach vulnerable populations with health-related          state offices spread across Nigeria’s six geopolitical zones.
     Target groups are sexually active women aged 20-49 years             steering committee and                                          communication messages and products and services.                     http://www.sfhnigeria.org/
     of age (primary target group – which is in turn segmented to      3. International advocacy, Linking & Learning and                  http://www.psi.org/Zimbabwe
     maximize outreach) and male partners (secondary target group).       Communication.

     The PSI socially marketed female condom complements the           The programme donors are Danida, the Netherlands Ministry of
     public sector free distribution condom to achieve the total       Foreign Affairs, The William and Flora Hewlett Foundation, Sida,
     market condom distribution approach used in the country. The      Oxfam Novib and Norad (for 2008).
     socially marketed condom is distributed through private sector    http://www.condoms4all.org
     channels while the public sector condom is distributed free in
     public sector institutions.
     http://www.psi.org/Zimbabwe                                       The following organizations have contributed to the
                                                                       Implementation Guide:

     Female Condom Programme Mozambique                                Association Camerounaise Pour le Marketing Social (ACMS)
     The Female Condom Programme in Mozambique is a three-year         Set up in 1996, following an agreement between the government
     programme, operational since January 2011. The programme          of Cameroon and Population Services International, ACMS is
     is currently being implemented in Maputo and Nampula              an association under Cameroonian law. Its objectives are to
     provinces by a consortium of three organisations: Fórum           contribute with other health and development stakeholders in
     Mulher, Pathfinder International and PSI/Mozambique. The          the conception and the implementation of strategies to improve
     overall goal of the programme is to contribute to the reduction   the social welfare of Cameroonian populations.
     of the number of HIV infections and unwanted/unplanned            ACMS facilitates the population’s access to good information,
     pregnancies among the sexually active population.                 services and quality products in the domains of HIV prevention,
     The organisations within the consortium complement each           malaria prevention, family planning, fight against diarrhoeic
     other’s expertise in a very effective manner: Fórum Mulher        diseases and reproductive health.
     is very strong in advocacy, with a vast network of women’s        http://www.acms-cm.org/
     organisations under its umbrella; Pathfinder International




90                                                                                                                                                                                                                                                                                  91
92   Dutch MP Kathleen Ferrier makes her statement on a Paper Doll
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